Case Study Report
Written by Kevin Riley, Senior Clinical Specialist, Paragonix Technologies, Inc.:
“What is Measured is Managed!”
A Quick Dash Across Town to Transport a Donor Heart with Perfect Temperature Management using Paragonix SherpaPak™ Cardiac Transport System
This recent Case Study Report of the Paragonix SherpaPak™ Cardiac Transport System involved a short distance donor heart procurement. The Paragonix SherpaPak™ Cardiac Transport System demonstrated optimal temperature management immediately upon placement of the donor heart into the System and provided for excellent graft function post-implantation.
Recipient and Donor Background
The recipient patient was a female with a history of heart disease and heart failure requiring heart transplantation at a Boston teaching hospital. A female donor with anoxic brain injury secondary to an overdose with no history of heart disease was identified at an area hospital. Infectious disease results indicated the donor was Hep C positive.
Method of Donor Heart Transport
The Paragonix SherpaPak™ Cardiac Transport System (CTS) was the chosen method for donor heart preservation and transport.
Prior to use, the Paragonix SherpaCool™ Ribbons and Pouch had been preconditioned in a -20°C freezer for 48 hours and prior to recovery team departure to the donor hospital. The Paragonix SherpaCool™ material was transported in an ice chest with four (4) liters of preservation solution.
Donor Heart Recovery
After skin incision, donor heart recovery was delayed approximately 2 hours due to a challenging explant at the recipient site. Prior to donor heart cross clamp, three (3) liters of cold preservation solution were decanted into the sterile Paragonix SherpaPak™ organ canister, which is designed to hold the heart. Prior to placement within the organ canister, the heart was flushed in situ with one (1) liter of cold preservation solution, recovered, and then placed in a basin with slush for inspection and insertion of the Paragonix SherpaPak™ Heart Connector into the aortic root. The Paragonix SherpaPak™ Heart Connector was attached to the aorta using umbilical tape. The heart was then anchored to the organ canister, which was quickly assembled and inserted into a second rigid sterile outer canister designed for additional protection and serving as a second, rigid sterile barrier. The final assembly was then placed into the Paragonix SherpaPak™ Shipper, which had been
previously preconditioned with the Paragonix SherpaCool™ material. Continuous and real-time temperature monitoring and recording was initiated from within the inner canister via an integrated thermocouple probe. The donor heart was now prepared for ambulance transport back to the recipient hospital.
Transport to Recipient and Preparation of Donor Heart for Implantation
Time in the ambulance from donor hospital to recipient hospital was approximately 10 minutes. Upon removal of the donor heart from the Paragonix SherpaPak™ CTS, temperature records were downloaded and reviewed.
Transport and Total Ischemic Time
The total time of storage and preservation within the Paragonix SherpaPak™ CTS was 24 minutes. The total ischemic time was 116 minutes.
Transport and Temperature Results
The initial preservation solution temperature within the Paragonix SherpaPak™ Organ Canister holding the donor heart was 4.82°C, with a mean temperature of 5.32°C. The lowest temperature recorded during the transport was 4.82°C and the highest temperature recorded was 6.05°C. These temperatures were within the operating range of 4 to 8°C for optimal preservation and prevention of frostbite and cold damage. The Paragonix SherpaPak™ CTS was wheeled to the ambulance, secured using straps, and easily transported from the vehicle to the recipient OR.
Patient and Graft Outcome
The recipient’s post-transplant transthoracic echocardiogram showed normal biventricular function with an LVEF of 76%. Right heart catherization showed normal RA, normal RV, normal PAP, normal PCWP and normal CO using the Fick method. She was discharged
home on post-operative day 12.