The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
A New HOPE for Hypoplastic Left Heart Syndrome: Technique for Primary En-Bloc Heart and Aorta Transplant with Hypothermic Oxygenated Recovery of a DCD Heart.
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Thomassen Maja Brøgger, Moeslund Niels, McCheyne Alan, Bivona Chris, Henriksson Henrik, Warburton James, Lenbroch Klaes Vincent, Helming Lukas, Walker Matthew, Runge Marx, Henderson Paul, Kenny Louise Amelia
Аннотация
BACKGROUND: Primary heart transplantation for hypoplastic left heart syndrome (HLHS) has been limited by the scarcity of neonatal donors. Although hypothermic oxygenated machine perfusion (HOPE) enables donation after circulatory death (DCD) heart transplantation, previous cannulation techniques sacrificed the donor aortic arch, precluding the reconstruction required for HLHS.
METHODS: A neonatal-sized porcine DCD heart was recovered with the entire thoracic aorta preserved en-bloc using a novel split-cannulation strategy compatible with HOPE. Following 304 minutes of ex situ preservation, the heart-aorta graft was transplanted into a recipient after reconstruction designed to replicate HLHS anatomy. Graft function, haemodynamics, myocardial oedema, and systemic outflow were assessed.
RESULTS: The split-cannulation strategy enabled stable HOPE preservation of the intact heart-thoracic aorta graft throughout ex situ perfusion. Myocardial oedema was minimal (8% weight increase during preservation, 2% above baseline after transplantation). Successful implantation was demonstrated by spontaneous recovery of electrical activity, restoration of sinus rhythm, progressive improvement in cardiac output, and satisfactory ventricular contraction on epicardial echocardiography. No significant pressure gradient was detected across the reconstructed aortic arch.
CONCLUSIONS: This study demonstrates the technical feasibility of recovering, preserving, and transplanting an intact neonatal-sized DCD heart-thoracic aorta graft using a novel split-cannulation HOPE strategy. By preserving the donor thoracic aorta for arch reconstruction, this technique overcomes a key anatomical barrier to primary DCD heart transplantation for HLHS and provides the technical foundation for clinical translation.
METHODS: A neonatal-sized porcine DCD heart was recovered with the entire thoracic aorta preserved en-bloc using a novel split-cannulation strategy compatible with HOPE. Following 304 minutes of ex situ preservation, the heart-aorta graft was transplanted into a recipient after reconstruction designed to replicate HLHS anatomy. Graft function, haemodynamics, myocardial oedema, and systemic outflow were assessed.
RESULTS: The split-cannulation strategy enabled stable HOPE preservation of the intact heart-thoracic aorta graft throughout ex situ perfusion. Myocardial oedema was minimal (8% weight increase during preservation, 2% above baseline after transplantation). Successful implantation was demonstrated by spontaneous recovery of electrical activity, restoration of sinus rhythm, progressive improvement in cardiac output, and satisfactory ventricular contraction on epicardial echocardiography. No significant pressure gradient was detected across the reconstructed aortic arch.
CONCLUSIONS: This study demonstrates the technical feasibility of recovering, preserving, and transplanting an intact neonatal-sized DCD heart-thoracic aorta graft using a novel split-cannulation HOPE strategy. By preserving the donor thoracic aorta for arch reconstruction, this technique overcomes a key anatomical barrier to primary DCD heart transplantation for HLHS and provides the technical foundation for clinical translation.