Comment
This technique enables us to start flushing the heart within 3 minutes of skin incision. We have successfully used this technique in all the 12 DCD heart transplants with good outcome (all the recipients are doing well with normal graft function). Moreover, in this technique, the assistant is not required to support the Foley with his hands. Instead, his hands will be free to assist the surgeon with venting of the IVC and the LV. During the 2 dry-run procurements, we tried to use the regular cardioplegia catheter. The catheter dislodged from the aorta during perfusion which wasted time and preservation solution. The process of reinserting the cannula into the aorta was cumbersome given the pericardial cavity was full of blood and fluids. We apply the aortic cross-clamp before inserting the Foley catheter into the aorta to avoid incidental clamping the soft Foley catheter tip.
Warm ischemia time has a detrimental effect on the survival outcome of DCD heart transplantation. Sánchez-Cámara et al.3conducted a study to determine the impact of warm ischemia time on human cardiomyocytes function and viability. They concluded that myocardial contractility and cellular viability are significantly affected during the 10 minutes after cardiac arrest. The time interval before cardiac arrest during which life support therapy (LST) was withdrawn did not have a significant impact on heart function provided that the LST withdrawal time interval was < 20 min. Given the 5-minute stand-off period mandated by most institutions, Sánchez-Cámara et al.3 recommended the heart to be perfused within 5 minutes from skin incision. This includes the time required to collect about 1500 cc of donor blood in the DPP technique. Our technique demonstrates how preparation of a simple Foley catheter can mitigate the deleterious effect of warm ischemia time on the myocardial viability and contractility.