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therapy (LST) was withdrawn did not have a significant impact on heart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.