From Ice to Perfusion: A Narrative Review of Modern Heart Preservation Systems
4 affiliations
- 1Unit of Cardiac Surgery, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- 2Unit of Cardiac Surgery, AOPG Santa Maria della Misericordia Hospital, 06156 Perugia, Italy
- 3Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- 4Department of Experimental and Clinical Medicine, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
Abstract
Donor heart preservation is still a critical determinant of outcomes after heart transplantation, particularly as transplant programs increasingly rely on extended-criteria and donation-after-circulatory-death donors. This narrative review provides an overview of the evolution of donor heart preservation, from conventional static cold storage to contemporary technologies designed to reduce ischemia–reperfusion injury, improve graft assessment, and expand organ utilization. We discuss the physiological rationale and clinical evidence supporting commonly used cardioplegic solutions, including University of Wisconsin, Celsior, and histidine–tryptophan–ketoglutarate solutions. We then examine advanced preservation strategies, including controlled hypothermic preservation systems and ex vivo normothermic machine perfusion, which allow improved temperature control, continuous monitoring, functional assessment, and, in the case of machine perfusion, potential metabolic optimization of the graft during transport. Current evidence suggests that these technologies could extend acceptable preservation times, facilitate long-distance procurement, and support the use of marginal and DCD grafts. However, their widespread adoption is limited by logistical complexity, costs, and the need for further independent studies evaluating long-term clinical outcomes. Modern preservation platforms can represent a major paradigm shift in heart transplantation, with the potential to improve graft availability and post-transplant outcomes.
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BibTeX
@article{barbato2026from,
title = {{From Ice to Perfusion: A Narrative Review of Modern Heart Preservation Systems}},
author = {Raffaele Barbato and Benedetto Ferraresi and Mohamad Jawabra and Francesco Loreni and Alessandro Strumia and Marcello Bergonzini and Giuseppe Santarpino and Massimo Chello},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208114},
url = {https://www.mdpi.com/2077-0383/15/20/8114},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From Ice to Perfusion: A Narrative Review of Modern Heart Preservation Systems
AU - Raffaele Barbato
AU - Benedetto Ferraresi
AU - Mohamad Jawabra
AU - Francesco Loreni
AU - Alessandro Strumia
AU - Marcello Bergonzini
AU - Giuseppe Santarpino
AU - Massimo Chello
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208114
UR - https://www.mdpi.com/2077-0383/15/20/8114
AB - Donor heart preservation is still a critical determinant of outcomes after heart transplantation, particularly as transplant programs increasingly rely on extended-criteria and donation-after-circulatory-death donors. This narrative review provides an overview of the evolution of donor heart preservation, from conventional static cold storage to contemporary technologies designed to reduce ischemia–reperfusion injury, improve graft assessment, and expand organ utilization. We discuss the physiological rationale and clinical evidence supporting commonly used cardioplegic solutions, including University of Wisconsin, Celsior, and histidine–tryptophan–ketoglutarate solutions. We then examine advanced preservation strategies, including controlled hypothermic preservation systems and ex vivo normothermic machine perfusion, which allow improved temperature control, continuous monitoring, functional assessment, and, in the case of machine perfusion, potential metabolic optimization of the graft during transport. Current evidence suggests that these technologies could extend acceptable preservation times, facilitate long-distance procurement, and support the use of marginal and DCD grafts. However, their widespread adoption is limited by logistical complexity, costs, and the need for further independent studies evaluating long-term clinical outcomes. Modern preservation platforms can represent a major paradigm shift in heart transplantation, with the potential to improve graft availability and post-transplant outcomes.
SN - 2077-0383
ER -