Innovative approaches to organ preservation in heart transplantation: A comprehensive review by the French Society of Thoracic and Cardiovascular Surgery.

Improved approaches for organ preservation have been recently applied in heart transplantation to prevent the risk of primary graft dysfunction. To review heart-graft preservation systems and to identify criteria for using innovative devices in each specific situation. A working group of the French Society of Thoracic and Cardiovascular Surgery performed a literature review focusing on organ preservation and post-transplant outcomes. Static cold storage is the most widely used method but involves cold ischaemia and is therefore limited for prolonged preservation. Optimizing this method by ensuring uniform and stable cooling (SherpaPak™) seems to be associated with favourable results, even with expanded-criteria grafts. Continuous normothermic organ perfusion (Organ Care System) shortens the cold ischaemia time, thus maintaining heart-graft viability despite long transportation times or long waits to achieve complex recipient-heart explantation. Moreover, this method can rehabilitate Maastricht III heart grafts. Continuous hypothermic oxygenated perfusion (XVivo™, not yet approved by regulatory authorities) has recently been associated with favourable outcomes, even in case of extended out-of-body preservation>8hours. The new devices for heart preservation can be expected to allow successful transplantation despite long transport times, lengthy explantation procedures and the use of grafts from expanded-criteria donors, including donors after controlled circulatory arrest. Further studies are needed to assess patient and graft outcomes, determine the optimal device for each situation and evaluate the cost-benefit ratio.