Guihaire Julien, Guimbretière Guillaume, Lebreton Guillaume, Allain Géraldine, David Charles-Henri, Pozzi Matteo, Para Marylou, Flecher Erwan, Bouchot Olivier, Leprince Pascal, Vincentelli André
Cardiac Surgery and Transplantation, Marie-Lannelongue Hospital, groupe hospitalier Paris Saint-Joseph, université Paris Saclay, 133, avenue de la Resistance, 92350 Le Plessis Robinson, France.
Cardiac Surgery, Thoracic and Vascular Surgery Department, institut du thorax, University Hospital of Nantes, 44000 Nantes, France.
Arch Cardiovasc Dis. 2025 Sep;118(8-9):489-496. doi: 10.1016/j.acvd.2025.03.119. Epub 2025 Apr 9.
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.
为预防原发性移植物功能障碍的风险，最近在心脏移植中应用了改进的器官保存方法。旨在回顾心脏移植物保存系统，并确定在每种特定情况下使用创新设备的标准。法国胸心血管外科学会的一个工作组进行了一项文献综述，重点关注器官保存和移植后结果。静态冷藏是最广泛使用的方法，但涉及冷缺血，因此在延长保存时间方面存在局限性。通过确保均匀稳定的冷却（SherpaPak™）来优化此方法似乎会带来良好的结果，即使是对于边缘供心。持续常温器官灌注（器官护理系统）缩短了冷缺血时间，因此即使运输时间长或等待复杂的受体心脏切除时间长，也能维持心脏移植物的活力。此外，这种方法可以使马斯特里赫特III级心脏移植物恢复功能。持续低温氧合灌注（XVivo™，尚未获得监管机构批准）最近也取得了良好的效果，即使在体外保存时间延长>8小时的情况下也是如此。预计新的心脏保存设备将能够实现成功移植，尽管运输时间长、切除程序冗长以及使用边缘供体的移植物，包括控制性循环骤停后的供体。需要进一步研究以评估患者和移植物的结果，确定每种情况下的最佳设备，并评估成本效益比。
