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The standard technology for heart preservation for transplantation is cold static storange on ice. No temperature control is performed routinely and therefore lower or higher temperatures can occur leading to injury of the graft. The SherpaPakTMCardiac Transportation System (CTS) (Paragonix Technologies, MA, USA) has been approved in Europe and the USA for clinical use and can keep temperatures stable between 4-8°C We report our two-year clinical experience in high risk transplants with the SherpaPakTM Since November 2018 SherpaPakTM has been used in 19 non-consecutive cases in our institution. Decision to use the device was done in procurements with either high-risk donors, long ischemic times (>180 minutes) or both. High risk donors were defined as donors with ≥1 risk factor (Age>50, previous CPR, Hypernatraemia >160mmol/l, >0.3μg/kg/min Norepinephrine, ≥1 inotropic drug for hemodynamic support, LVEF≤50%, septum thickness >12mm. Recipient risk was calculated according to the Impact Score (Weiss et al Ann Thorac Surg 2011). Primary graft dysfunction (PGD) was defined according to ISHLT consensus from 2014. Transplants had an average of 2,37±1,26 risk factors. 86% of transplants showed long ischemic times (median 201 minutes, 25%-75%: 189-290). 32% of donors had previous CPR, 26% were >50 years of age (Median age 40), 21% had high catecholamine support, 16% showed hypernatraemia and hypertophy respectively. 11% showed LVEF <50%. 89% of recipients were male and 58% had previous sternotomies (6 VAD). Median recipient impact score was 8 (25%-75%: 5,75-10). Donor hearts were preserved at a median temperature of 5,5°C. 2 recipients each showed PGD grade 3 (10,5%) and PGD 2 (10.5%) after weaning from bypass. All patients were supported with ECMO and all grafts recovered to normal graft function within 72 hours post transplant. All patients could be extubated within 7 days post transplant. Overall two-year survival was 79% in this high risk population The Paragonix SherpaPakTM provides consistent temperature during transportation of grafts and could be successfully used with long ischemic times and high-risk donor hearts. [ABSTRACT FROM AUTHOR]

During the global COVID-19 pandemic heart transplantation in Europe was affected due to difficultly traveling internationally and greater delays associated with crossing borders. During a similar time frame our center also adopted the Paragonix SherpaPak Cardiac Transport System (SHRP) for regular use rather than conventional ice storage (ICE). This study aims to compare heart transplant baseline characteristics and outcomes for the 18 months prior to the global pandemic with the 18 months since the pandemic began. The Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN) study is a retrospective, multi-institutional registry. We analyzed patients transplanted in Austria pre-pandemic, from 1 SEP 2018 to 1 MAR 2020 (PRE), with patients transplanted during the pandemic, from 1 MAR 2020 to 1 SEP 2021 (C19). 83 patients (42 PRE, 41 C19) met these criteria to be included in the analysis. The PRE cohort utilized donor organs from statistically longer travel distances (PRE=323 v C19=179 miles, p=0.02). Despite the shorter travel distances, ischemic times were same (PRE=195 v C19=189 min, p=0.60), likely indicating the additional burdens for traveling across borders. During the PRE period the SHRP was only used for marginal cases and in the C19 period it was adopted for regular use. The proportion of cases utilizing SHRP was statistically higher in the C19 cohort (PRE=19% v C19=80%, p<0.001). The PRE cohort showed numerically higher rates of newly placed ECMO post-transplant (16.1% v 11.8% p=0.18), incidence of PGD (16.7% v 4.9%, p=0.08), incidence of severe PGD (4.8% v 2.4%, p=0.57), and rates of the use of cardioversion intra-operatively to start the donor heart (19.0% v 9.8%, p=0.32) for PRE v C19 respectively. In-hospital survival was similar (92.9% v 90.2%, p=0.67). The global COVID-19 pandemic caused a substantial impact on the access to donor hearts in Europe due to the ability to travel internationally. Despite this limitation on donor heart access, we saw trends towards improved outcomes in this period compared to the pre-pandemic period. This period was also highly correlated with the implementation of the Paragonix SherpaPak Cardiac Transport System as a preservation method which may have helped mitigate some of the negative effects of reduced donor access. [ABSTRACT FROM AUTHOR]