Role of Concomitant Valve Surgery in Orthotopic Heart Transplant

*Yasuhiro Shudo*

### **Abstract**

There remains a significant shortage of donor hearts despite an ever-increasing demand. In an effort to maximize the utilization of this scarce resource, extended criteria for donor hearts with surgically correctable abnormalities should be considered. Bench valve surgery on the donor heart prior to heart transplantation is feasible, and its implementation could enable the use of previously unsalvageable hearts, thus expanding the donor organ pool. With proper donor and recipient selection, bench valve surgery will enable the expansion of the donor pool to provide high-quality donor allografts that would otherwise have been declined. This chapter reviews the current practices employed in heart transplantation, with emphasis on the surgical technique for concomitant valve surgery in the donor heart prior to transplantation.

**Keywords:** orthotopic heart transplant, donor valve disease, bench valve surgery

### **1. Introduction**

Orthotopic heart transplantation is the gold standard treatment for end-stage heart failure [1]. According to the 2019 Registry of the International Society for Heart and Lung Transplantation, approximately 5000 heart transplantations were performed from July 1, 2017, to June 30, 2018 [2] (**Figure 1**). With the increasing prevalence of heart failure, it is estimated that over 25,000 patients annually can benefit from heart transplantation [3].

There are approximately 3000 candidates on the heart transplant waiting list in the United States. The mortality rate on the waiting list is approximately 15%, and the annual number of heart transplants is approximately 2500. Thus, there remains a severe shortage of donor hearts despite an ever-increasing demand. In an effort to maximize the utilization of this scarce resource, extended criteria for donor hearts with surgically correctable abnormalities should be considered [4]. Although there is consensus that mild valvular abnormalities in the donor may be amenable to repair or replacement on the bench [5], only a limited number of reports [6–16] in the literature exist, and a standardized technique has not been well established or adopted.

This chapter reviews the current practices employed in heart transplantation, with emphasis on the surgical technique for concomitant valve surgery in the donor heart prior to transplantation.

**Figure 1.**

*Number of adult and pediatric patients who underwent orthotopic heart transplantation by year, from the International Society for Heart and Lung Transplantation 2019 report.*
