Outcomes with controlled moderate hypothermic preservation vs static cold storage in heart transplantation

Results from an analysis of the GUARDIAN-Heart Registry (NCT04141605), an international, multicenter, real-world registry evaluating controlled moderate hypothermic preservation using a cardiac transport system (CTS) vs conventional ice storage in adults undergoing heart transplantation, were published in The Journal of Heart and Lung Transplantation by Silvestry et al. The study compared post-transplant outcomes, including graft dysfunction and survival, between recipients of donor hearts preserved using the CTS (n = 695) and those preserved with conventional ice storage (n = 566).

Key data: Preservation using the CTS was identified as an independent predictor of reduced severe primary graft dysfunction (PGD; odds ratio [OR], 0.60; 95% confidence interval [CI], 0.40–0.89; p = 0.012) and right ventricular dysfunction (RVD; OR, 0.75; 95% CI, 0.57–1.00; p = 0.047). In propensity score-matched (PSM) analysis (n = 362 per group), use of the CTS was associated with lower rates of severe PGD (5.5% vs 11.0%; p = 0.008), severe RVD (5.5% vs 9.8%; p = 0.047), and post-transplant mechanical circulatory support (MCS; 19.1% vs 27.9%; p = 0.007) compared with ice storage. Two-year survival was higher with use of the CTS (94.3% vs 89.5%; p = 0.042), corresponding to a 47% reduced risk of death (hazard ratio [HR], 0.53; 95% CI, 0.30–0.92; p = 0.024). 

Key learning: Controlled moderate hypothermic heart preservation using a CTS was associated with improved post-transplant outcomes, including reduced graft dysfunction and higher 2‑year survival, compared with conventional ice storage.