Protocol for partial heart transplantation of the pulmonary valve in a swine model: surgical technique, postoperative care, assessments and outcomes.

Piglets serve as an excellent model for cardiovascular research due to the anatomic and physiological similarities between the porcine and human heart. This study establishes an improved protocol for performing partial heart transplantation (PHT) in a swine model, addressing key technical and physiological challenges while optimizing perioperative management. Here we present the results of performing the PHT protocol in 70 piglets (35 donors and 35 recipients) using a standardized approach incorporating sternotomies, vascular anastomoses, and immunosuppression, and 6 unoperated controls. Intraoperative complications, primarily due to hemodynamic instability and arrhythmias, occurred in 22.9% of recipients (n = 8/35), while postoperative complications, primarily due to failure to thrive and infections occurred in 29.6% of the survivors (n = 8/27). Refinements such as prophylactic antiarrhythmic therapy, use of clamps to control bleeding in the field, and optimized selection of suture materials improved operative and post-operative outcomes over the course of the study. This protocol demonstrates the feasibility of PHT in a swine model and provides a framework for evaluating clinical partial heart transplant protocols.