For the first time, the surgeon successfully performed an incredible new heart transplant in which the donor organ does not skip beats in the process, reducing the damage that can occur during such a complicated procedure. It will lead to a new era of more successful heart transplant surgery.
A team of surgeons at the National Taiwan University Hospital (NTUH) in Taipei took on the revolutionary work. Meanwhile, the donor's heart continues to beating during the removal of the organ and transplant stages. Traditionally, donor hearts are removed and stored in cold storage to reduce workload. At this stage, it is considered “at the time of ischemia” or the period during which organs are blocked from the blood supply. This carries a risk of heart damage and rejection when implanted in a recipient.
When the heart is deprived of blood, ischemia – lack of oxygen – damages the muscle tissue, or myocardium, reducing function and health after implantation. Although organ sets for implantation rarely endure ischemia for more than a few hours, they can still lead to myocardial damage.
So the NTUH team skips this interim skip, performs a zero ischemia time transplant, and the heart continues beating between the bodies.
“We wanted to have a heart transplant during ischemia so that the heart didn't have to stop, and we also managed to avoid injuries that normally occur after recurrence,” said Chi Nai-Hsin, the cardiovascular center physician, at a press conference at Taipei Hospital on Wednesday, April 16th.
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This operation was performed thanks to a specially designed organ maintenance system that continues to pump the donor's heart with oxygenated blood throughout the process. The NTUH Organ Care System (OCS) was inspired by extracorporeal membrane oxygenation (ECMO), a type of life support system that complements the heart and lung function.
With the heart hooked into this OCS, the organ was transported from one operating room to another without skipping the beat.
As for the patient, the 49-year-old woman with dilated cardiomyopathy was discharged from the hospital shortly after surgery last August, and is on track. Subsequent postoperative appointments indicate that women maintain low levels of cardiac enzymes. This surges typical transplant symptoms and indicates myocardial damage.
“We demonstrated the safety and feasibility of the surgery,” Chi said.
Overall, NTUH has performed around 700 heart transplant surgeries, but the team hopes to use OCS to skip ischemia time in the future.
Interestingly, in 2023 and 2024, Stanford University published a paper detailing its own beating heart implant operations, but in previous procedures the heart had undergone a short period of ischemia (10-30 minutes) between removal and connection to the support system.
In both NTUH operations, “My heart was still beating before procurement, and after procurement it continued to beat and never stopped – Ischemia time was achieved,” said Chen Yi Sharne, head of the hospital's organ transplant team.
The team said they will continue to improve the procedures and build on organ maintenance techniques, allowing more people to benefit from zero ischemia time transplants.
The case study is Journal of Thoracic and Cardiovascular Surgery TechniquesPrepoof versions are currently available.
