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Cold storage preservation is the standard approach for heart transplantation but is a time-limited method of care. Ex vivo heart perfusion expands the donor pool due by mitigating time and distance barriers and allows the possibility to improve graft function. We report long term follow up of a successful heart transplantation following an ex vivo time of 17 h using the Organ Care System in a patient with a left ventricular assist device.

Background Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). Methods Between 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study. Results During this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5). Conclusion Normothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.

Objectives Cold crystalloid cardioplegia for donor heart harvesting and cold ischemic storage conditions during the transportation is the standard of care during heart transplantation procedure. Organ care system (OCS) was introduced for more prolonged and reliable ex vivo organ management. This study evaluated the two different techniques used for myocardial preservation during the procurement and transportation of the heart using the OCS. Methods We performed prospective analysis of 43 patients with heart failure undergoing heart transplantation and using the OCS for donor organ transport. Donor hearts were arrested using blood cardioplegia and conditioning (n = 30) or standard Custodiol (SC) solution ( n = 13). Perfusion and cardiac function parameters were continuously monitored while the donor hearts were perfused in the OCS. Impact of preservation techniques on biochemical parameters and clinical outcomes were evaluated. Results All donor hearts had stable perfusion and lactate characteristics in the OCS, with similar measures between the two groups at the beginning of the ex vivo perfusion. Ex vivo heart perfusion mean ending concentration of Interleukin (IL)‐6 and IL‐8 was significantly lower in the blood cardioplegia group compared to the standard care group. Clinical outcomes were comparable between the two groups of patients. Conclusions The use of blood cardioplegia and conditioning could be a safe method for myocardial protection in distant procurement and preservation of donor hearts in the OCS.

The CARMAT-Total Artificial Heart (C-TAH) is designed to provide heart replacement therapy for patients with end-stage biventricular failure. This report details the reliability and efficacy of the autoregulation device control mechanism (auto-mode), designed to mimic normal physiologic responses to changing patient needs. Hemodynamic data from a continuous cohort of 10 patients implanted with the device, recorded over 1,842 support days in auto-mode, were analyzed with respect to daily changing physiologic needs. The C-TAH uses embedded pressure sensors to regulate the pump output. Right and left ventricular outputs are automatically balanced. The operator sets target values and the inbuilt algorithm adjusts the stroke volume and beat rate, and hence cardiac output, automatically. Auto-mode is set perioperatively after initial postcardiopulmonary bypass hemodynamic stabilization. All patients showed a range of average inflow pressures of between 5 and 20 mm Hg during their daily activities, resulting in cardiac output responses of between 4.3 and 7.3 L/min. Operator adjustments were cumulatively only required on 20 occasions. This report demonstrates that the C-TAH auto-mode effectively produces appropriate physiologic responses reflective of changing patients' daily needs and represents one of the unique characteristics of this device in providing almost physiologic heart replacement therapy.

OBJECTIVES: Patients with mechanical circulatory support bridged to a heart transplant (HTx) are at higher risk of postoperative graft dysfunction. In this subset, a mode of graft preservation that shortens graft ischaemia should be beneficial. METHODS: The outcomes of 38 patients on mechanical circulatory support (extracorporeal life support, left ventricular assist device and biventricular assist device) who received a HTx between 2015 and 2020 were analysed according to the method of graft preservation: cold storage (CS) group, 24 (63%) or ex vivo perfusion (EVP) group, 14 (37%). RESULTS: The median age was 57 (range 30–73) vs 64 (35–75) years (P = 0.10); 88% were men (P = 0.28); extracorporeal life support was more frequent in the CS group (54% vs 36%; P = 0.27) versus left ventricular and biventricular assist devices in the EVP group (46% vs 64%; P = 0.27). Clamping time was shorter in the EVP group (P 4 h was higher in the CS group (P = 0.01). Thirty-day mortality was 13% (0–27%) in the CS group and 0% (P = 0.28) in the EVP group. A significantly lower primary graft failure [7% (0–23%) vs 42% (20–63%); P = 0.03] was observed in the EVP group. Survival at 1 year was 79 ± 8% (63–95%) in the CS group and 84 ± 10% (64–104%) in the EVP group (P = 0.95). CONCLUSIONS: Our results support the use of ex vivo graft perfusion in patients on mechanical circulatory support as a bridge to a HTx. This technique, by shortening graft ischaemic time, seems to improve post-HTx outcomes.

Background. Mechanical circulatory support (MCS) has been applied as an effective therapy for patients with end stage heart failure (HF). The existing donor organ shortage issue in Kazakhstan, and hence long waiting times, have resulted in left ventricular assist device (LVAD) implantation being the predominant surgical treatment method for this condition. The purpose of this study is to analyze clinical outcomes of MCS program data in our Center. Methods. This study involves a retrospective analysis of 324 patients with different types of implantable MCS including LVAD (n=319), fully implantable LVAD (FIVAD, n=2), and total artificial heart (TAH, n=3). FIVAD and TAH cases were analyzed separately from other VAD types due to their small numbers. Results. Initially, LVADs were implanted as bridge-to-transplant (BTT) in 214 (67.1%) of patients and as a destination therapy (DT) in 105 (32.9%) cases, but only 30 (9.4%) patients proceeded to transplant. The overall survival rate of all LVAD patients at years 1, 2, 3, and 4 was 84.3%, 69.7%, 62.8%, and 52.5%, respectively. The distance from the clinic (Nur-Sultan) to patients’ cities of residence (average 1015 ± 668 kilometers) was not associated with patient survival. Conclusions. Developing MCS programs is crucial in providing care for patients with HF. Using LVAD as DT produced satisfactory outcomes with favorable survival rates, which are comparable to the outcomes reported in other studies. Further trials are needed to investigate the results of TAH and FIVAD implantation in order to establish them as an acceptable alternative treatment to heart transplantation.

Left ventricular assist device (LVAD) outflow graft injury is a very rare complication after LVAD implantation and is usually treated surgically. This is a case report of successful stenting of the damaged outflow graft 2.5 years after LVAD implantation, followed by successful heart transplantation.

Aims The need for the left ventricular assist devices (LVAD) in patients with end-stage heart failure is well established, but prior to 2011, this was not available to patients in Kazakhstan. We describe the development of the sole LVAD programme in the context of a nascent heart transplantation programme and clinical outcomes for the first three years. Methods and results From November 2011 to November 2014, 146 patients underwent implantation of 152 VADs (approximately 50 devices implanted per year). We retrospectively analyzed data from 135 LVAD patients who received HeartMate II (n = 95) or HeartWare (n = 40) devices. In 75 patients LVAD was used as a bridge-to-transplantation and in 60 patients as destination therapy, but only 3 of 135 LVAD patients received heart transplant. Forty-three patients of the LVAD cohort had died by the end of the follow-up period. The mean time on LVAD was 466 ± 330 days (range 5–1200 days). Kaplan–Meier survival estimates for patients who continued on LVAD support were 93% after 1 month, 86% after 6 months and 77% after 12 months. The most common complications within the first 30 days after implant included right ventricular failure (n = 20, 1.85 events/patient-year), renal failure (n = 19, 1.76 events/patient-year) and bleeding (n = 33, 3.0 events/patient-year). Beyond 30 days adverse events included driveline infections (n = 46, 0.56 events/patient-year) and stroke (n = 33, 0.21 events/patient-year). Conclusions LVADs are an important therapeutic alternative to heart transplantation in the context of a developing heart transplant programme with outcomes that are comparable to those reported by other centres.

Background. In 2012, we initiated the first heart transplant programme in Kazakhstan. Donor hearts are transported from distant regions (>1000 km) to be transplanted at our Center. The ob jective of this study was to assess the feasibility of blood cardioplegia as an alternative method to Custodiol for heart preservation. Methods. We performed a retrospective analysis of prospectively collected data. Between May 2014 and February 2016, 20 patients with heart failure underwent heart transplantation using the Organ Care System. Of these, we arrested the donor hearts before explant and before implant using blood cardioplegia and conditioning (ultrafiltration, levosimendan) in ten patients and with standard Custodiol in ten other patients. Results. Preoperative risk factors were comparable in both groups. All patients were alive on the 30th day post implant in both groups. Results were similar for the blood cardioplegia compared to the Custodiol groups for: mean total warm ischemic time was 84.2±28 vs 86.9±8.4 min (p=0.001). Mean ex vivo perfusion time was 266.5±86.7 vs 260.4±88.4 min (p=0.87). Mean venous lactate at the start of perfusion 2.2±0.7 vs 3.4±0.8 mmol/l and at the end of perfusion 5.0±1.9 vs 9.2± 2.1 mmol/l (p=0.001). Seven-day tissue myocardial Doppler results were normal in both groups, except for one patient in the Custodiol group who had right ventricular dysfunction. There were no statistically significant differences in ICU stay between the two groups. Mean ECMO duration was 29.5±28.4 vs 78.4±89 hours (p=0.002). Conclusion. Our observations show that blood cardioplegia and conditioning could be an alternative method for myocardial protection in distant procurement and preservation of donor hearts in the Organ Care System.

Aim. Kazakhstan is a country where mechanical circulatory support program was established prior to heart transplantation (HT). Given the countries large land area and small population density transportation of scarce amount of donor hearts was the primary challenge for healthcare providers. Advances in the area of cardiac surgery, such as development of left ventricular assist device (VAD) and organ care system (OCS) Transmedics, allowed us to overcome the obstacles. In this study we aim to analyze and describe the results of the first 5 years of heart transplantation program in Kazakhstan. Methods. A prospective descriptive study analyzing the data of 42 patients was conducted. All the enrolled study subjects have undergone heart transplantation within a period between 2012 and 2016 in the National Research Cardiac Surgery Center, Astana, Kazakhstan. Primary and secondary outcomes of interest were cumulative survival, graft failure free period and incidence of adverse events. Results. Kaplan-Meier survival estimates for all patients after HT were 90% after 3 months, 82% after six months and 80% after twelve months. In the early postoperative period after HT 11 (26.1%) patients have experienced the following adverse events: 13 (30%) resternotomy due to bleeding, 3 (7%) sepsis, 1 (2.3%) stroke, 2 (4.7%) lymphorrhea from groin area, 2 (4.7%) -heart rhythm disturbances, and 6 patients (14.3%) had pneumonia. No cases of graft rejection were recorded. Conclusion. With all the confidence we can state that Kazakhstan has fully benefited from new advances. OCS Transmedics allowed preserving the heart for much longer period of time and making long distance transportation of donor heart possible. This study can further be followed up by studying the HT outcomes after OSC compared to standard cold storage. Moreover, another research studying the impact of heart preservation time in the OCS on the outcome of patient survival after HT can also be conducted.

As a consequence of limited donor availability, there has been a growing interest for alternative strategies, such as left ventricular assist devices (LVAD) as either a bridge to transplantation (BTT) or as destination therapy (DT) for the treatment of the advanced heart failure. The heart transplant program in Kazakhstan is in a nascent stage and therefore patients that are determined to be BTT are expected to have an extended duration of LVAD support.