From April 1991 to January 1993, 37 orthotopic heart transplantations
were performed at our institution, Conventional preservation technique
with cold crystalloid cardioplegia and topical hypothermia during sto
rage and implantation was used in the first 15 cases (group A), After
January 1992, for the next 22 patients (group B), we administered a fi
rst dose of hyperkalemic blood cardioplegia on arrival of the graft an
d thereafter instituted continuous warm reperfusion by infusion of oxy
genated blood with added potassium. The groups were compared retrospec
tively, and significant differences were observed, In group B, the Isc
hemic time was shortened by 31 minutes, the suture time lasted 12 minu
tes longer, sinus rhythm recovered spontaneously, the duration of inot
ropic support was reduced, postoperative arrythmias decreased, length
of intensive care and hospital stays were reduced, there was less isch
emic damage in the first endomyocardial biopsy sample, and right ventr
icular pressures a month after operation were lower, Continuous warm r
eperfusion during implantation of the donor heart is technically feasi
ble and seems to provide enhanced myocardial preservation.