HF
SURG
Workshop
Nicolas Noiseux, MD, MSc, FRCSC
Cardiovascular Surgeon
Universite de Montreal
Vivek Rao, MD, PhD
Head, Cardiovascular Surgery
CSCS
Roberto Ribeiro, MD, PhD (c)
Surgical Research Fellow / PhD candidate
Mitesh Badiwala, MD, PhD
Surgical Director, Heart Transplantation
University of Toronto
A. David Nagpal, MD
Cardiac Surgeon
CSCS, CANCARE
Sam Shemie, MD
Pediatric Critical Care Specialist
McGill University
Filio Billia, MD, PhD
Medical Director, Cardiac Mechanical Support
Toronto General Research Institute
Mark Kearns, MD PhD FRCSC
Advanced Transplant/MCS Fellow
Anique Ducharme, MD FRCPC
Professor of Medicine, Heart Failure/Transplant Cardiologist
University of Montreal
Nadia Bouabdallaoui, MD
MD, Heart Failure Specialist
.png "Rakesh Arora, MD, PhD, FRCSC photo")
Rakesh Arora, MD, PhD, FRCSC
Head, Cardiac Surgery and Cardiac Critical Care
CSCS and CANCARE Society
Simon Maltais, MD
Heart Failure and Transplant Specialist
Yoan Lamarche, MD
President, CanCare
Montreal Heart Institute
While many treatments exist to alleviate symptoms or decrease mortality in heart failure patients, cardiac transplantation remains the gold-standard treatment for eligible patients with end stage disease. The standard method of organ procurement is Donation after Neurological Determination of Death (NDD), but less than 40% of the hearts get accepted for transplantation. Therefore, the lack of donor hearts creates a mismatch between the offer and demand for organs and maintains the significant mortality rate for patients on the waiting list. One valuable option to expand the donor organ pool is the use of hearts Donated after Circulatory Death (DCD). These, however, are invariably submitted to a period of unprotected ischemia potentially generating irreversible tissue damage. Because of the inability to precisely identify the extent at which hearts have sustained injury, there is a reluctance to use DCD hearts. A tailored approach to DCD hearts requires organ resuscitation at the time of procurement, continuous functional assessment, and improved methods for organ preservation. Ex Situ Heart Perfusion (ESHP) systems capable of reanimating and maintaining heart viability outside of the body are currently under development. However, the optimal system settings and perfusion solution composition to meet the heart’s energy requirements and facilitate adequate preservation remain to be optimized. Normothermic regional perfusion (NRP) has also been investigated as an alternative resuscitation strategy for DCD organs, restoring myocardial perfusion within the donor after exclusion of the cerebral circulation and allowing functional assessment of the donor heart before procurement. The aim of this workshop is to review current evidence regarding DCD heart transplantation, describe the different procurement and preservation approaches available and the main issues surrounding this modality, and overview the future research needs. Our overarching goal is to inform, update, and engage the entire cardiovascular community on this topic and its implications on the Canadian health care system. The workshop will be composed of an initial period of three 10-minute lectures covering the basic concepts of DCD heart transplantation: (1) What is donation after circulatory death, why do we need it, and how is it done? (2) DCD heart transplantation: from basic science to clinical practice. (3) DCD Heart in Canada: View from the CCDT. The second half of the workshop will be composed by a Pro versus Con mini-debate regarding Normothermic Regional Perfusion. Two 10-minute presentations will then take place describing the advantages, disadvantages, and ethical challenges of this procurement method.