Authors: Andreas Zuckermann, Johannes Gökler, Phillip Kaiser, Enise Ceran , Nina Neuber, Günther Laufer, Arezu Aliabadi-Zuckermann
The standard technology for heart preservation for transplantation is cold static storage on ice. No temperature control is performed routinely and therefore lower or higher temperatures can occur leading to injury of the graft. The Paragonix SherpaPak Cardiac Transportation System (CTS) (Paragonix Technologies, MA, USA) has been approved in Europe and the USA for clinical use. This single-use disposable device is designed for cold preservation of donor hearts. We report our first clinical experience with the SherpaPak.
Since November 2018 SherpaPak has been used in 6 non consecutive cases in our institution. Decision to use the device was done in procurements with either high risk donors, long ischemic times or both. Donor risk was calculated with both the Eurotransplant donor heart risk score and the donor heart risk index (both JHLT 2012). Recipient risk was calculated via the IMPACT score (Ann Thor Surg 2011).
Median recipient age was 64,5 years. All patients were male and 50% had previous sternotomies (2 VAD patients). Median impact score was 9,5 (17% expected 1 year mortality). All donors were male with a median age of 45,5 years. Median LVEF was 55%. Median norepinephrine support was 0,11mcg/kg/min. Median ET donor risk score was 18 (40% risk of non-acceptance) and median donor risk score was 7 (18% expected 1-year mortality). Median ischemic time was 290 minutes. Donor hearts were preserved at a median of 5,5C temperature. 4 Patients were successfully weaned from bypass at the first attempt with low inotropic support. 2 Patients developed primary graft dysfunction ISHLT Grade 2 and were weaned from bypass via ECMO. Both hearts recovered within 72 hours and ECMO could be explanted. All patients could be extubated within 7 days post transplant and are alive at a median of 5 months post transplant with normal graft function.
The Paragonix SherpaPak provides consistent temperature during transportation of grafts and could be successfully used with long ischemic times and high risk donor hearts.