A still beating heart was transplanted thanks to the new 'sterile box', a high technological level instrument. The exceptional transplant operation was performed at the Papa Giovanni XXIII hospital in Bergamo on March 19th. The organ arrived in the still functioning hospital structure, thanks to the special Ocs – Heart equipment for the preservation and care of organs, available in very few centers in Italy and recently supplied to the Bergamo hospital. It is the first heart transplant performed in the facility with the innovative system, a portable cardiac perfusion device also known as 'heart in a box', which represents one of the most significant technological innovations in the field of transplants and organ preservation.
The recipient of the donor heart was a 58-year-old who had been assisted with a mechanical ventricular assist device for approximately two years.. The patient is now well and has been discharged from intensive care. The heart was removed from the operating rooms of a hospital in another region by a mixed team of cardiac surgeons, anesthetists and perfusionists from Bergamo. After the donation, the donor's heart started beating again in the sterile box supplied with warm, oxygenated blood, to reduce the period of non-perfusion which is particularly harmful to the organs. It is this continuous infusion into the coronary arteries that ensures the contractility and pulsatility of the donor heart.
The advantages of the new technology
Cardiac surgeons can continuously monitor all the organ's values, evaluate the health status of the heart in real time, intervene to modify the hemodynamic and metabolic parameters with the aim of improving the functionality of the organ, but also evaluate with more time available whether to interrupt the transplant, if the donated heart is at high risk of immediate dysfunction. The 'heart in a box' has the advantage of being able to extend the time available for cardiac surgeons between the collection and the transplant. It is now possible to have the organ delivered to Bergamo from a suitable donor with a time exceeding the 4-6 hours required for transport, a time considered at risk due to early organ dysfunction. This makes it possible to go and recover the heart even when the hospital where the sample is to be taken is located in a geographical area that is not very accessible, for example because it is far from airports.
With this system, a note explains, “organs can be used that otherwise would have had little chance of reaching the recipient patient with the necessary functionality. Furthermore, it is possible to accept hearts with a non-optimal function and evaluate the quality of the organ before being able to use it for the transplant. “Having acquired this equipment, with a considerable investment by the hospital, means for us to make available to our patients on the waiting list an extra possibility to receive an organ as a donor”, explained Amedeo Terzi, head of the heart transplant program of the Papa Giovanni XXIII Asst.
The availability of organs for transplant remains very limited and in any case lower than the number of patients on the waiting list. This is also why every heart donated is extremely precious. According to the latest findings available at a national level, out of 190 hearts proposed for transplantation outside the region in 2022 by the various Italian centers, only 32 (16.8%) were accepted and ultimately 23 transplanted (12.1%). Among the various reasons for non-use, 37.4% of cases are due to the 'marginality of the organ', i.e. the assessment, for various reasons, that the organ is not suitable to guarantee sufficient functionality after transplantation. The innovative Ocs system can prove useful in helping to reduce this figure.
“Investing in technological equipment in the field of transplants means increasing the chances that a patient on the list for a donor organ, in this case the heart, can receive a life-saving treatment – stated Mauro Moreno, medical director of the Asst Papa Giovanni XXIII “In addition to having purchased this new equipment he concludes – we are also investing a lot on an organizational and technical level. We have introduced a surgical room reserved for emergencies during daytime hours, to limit overlaps between non-programmable surgical interventions and transplants and to increase the availability to accept donated organs from other centers”.
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