Innovations in transplant techniques for complex anomalies.

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-10-01 Epub Date: 2024-08-09 DOI:10.1097/MOT.0000000000001168
Katrien Vandendriessche, Filip Rega, Alexander Van De Bruaene
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Abstract

Purpose of review: With advances in the field of congenital cardiac surgery and in the management of congenital heart defects in early life, the population of adult congenital heart disease (ACHD) patients is increasing. End-stage heart failure is currently the main cause of cardiovascular mortality and is expected to increase in the coming years. This review summarizes recent innovations in transplant techniques, with special attention to what is known in the population of ACHD recipients.

Recent findings: The use of machine perfusion for heart preservation enables longer preservation times. Normothermic (organ care system - OCS) and hypothermic (hypothermic oxygenated perfusion - HOPE) machine perfusion will alleviate the time pressure associated with heart transplantation in the ACHD population, may allow for expansion of the geographical range in which donors can be matched and may improve graft quality. Donation after circulatory death (DCD) heart transplantation, either through direct procurement-machine perfusion (DP-MP) or thoraco-abdominal normothermic regional perfusion (TA-NRP) is a viable strategy to further expand the donor pool.

Summary: The use of machine perfusion and DCD donors in ACHD is feasible and shows promise. Time pressure and shortage of donors is even more critical in ACHD than in other patient populations, making these innovations particularly relevant. Further clinical experience and research is needed to elucidate their impact.

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复杂畸形移植技术的创新。
综述的目的:随着先天性心脏外科领域和早期先天性心脏缺陷治疗领域的进步,成人先天性心脏病(ACHD)患者的人数正在不断增加。终末期心力衰竭是目前心血管疾病死亡的主要原因,预计在未来几年还会增加。本综述总结了移植技术的最新创新,并特别关注ACHD受者群体的已知情况:使用机器灌注保存心脏可延长保存时间。常温(器官护理系统--OCS)和低温(低温氧合灌注--HOPE)机器灌注将减轻与ACHD人群心脏移植相关的时间压力,可扩大可匹配捐献者的地域范围,并可提高移植质量。通过直接获取-机器灌注(DP-MP)或胸腹腔常温区域灌注(TA-NRP)进行循环死亡(DCD)后捐献心脏移植,是进一步扩大捐献者库的可行策略。与其他患者群体相比,ACHD 患者面临的时间压力和供体短缺问题更为严峻,因此这些创新尤为重要。需要进一步的临床经验和研究来阐明它们的影响。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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