Technique
The institutional review board approval was exempted as it falls outside
its scope, and donor consent was obtained.
We describe a simple technique to insert and secure the preservation
solution delivery catheter into the ascending aorta during heart
procurement from DCD donors. This technique enables us to start flushing
the heart with the preservation solution within 3 minutes from skin
incision. Moreover, this technique secures the cannula to the ascending
aorta without placing a purse-string suture. We use a 14-Fr. 2-way Foley
catheter instead of using the regular cardioplegia catheter to flush the
heart. The Foley catheter is prepared on the back table by applying
several layers of wound closure tapes (Steri-stripsTM,
3M, Minneapolis, MN, USA) around the catheter shaft about 3 mm from the
balloon (Fig. 1). These Steri-strips layers prevent the catheter from
advancing into the lumen of the aorta and it alleviates any leak. We
check the balloon integrity and flush the catheter before use. A 5-cc
syringe is filled with sterile saline solution and connected to the
inflation port of the balloon. The Foley catheter lumen is connected to
the preservation solution tubing. The tubing system is carefully deaired
before cannulation. A fine-tip forceps (tonsil forceps) is applied to
the tip of the Foley catheter. After opening the chest and exposing the
ascending aorta, the aortic cross clamp is applied to the ascending
aorta and a 5-mm long transvers incision is made on the ascending aorta
just proximal to the clamp. With the attached tonsil forceps, the tip of
the Foley catheter is inserted into the aortic lumen and the assistant
inflates the balloon. Heart perfusion is initiated, and
the inferior vena cava (IVC) is
vented (Fig. 2, video). The left ventricle (LV) is vented, and the heart
is cooled in standard fashion.