Need For Extracorporeal Circulation Research Articles

Outcomes of Clampless Real Chimney Technique with Dacron Graft and Sleeve Banding of the Ascending Aorta for Total Debranching Endovascular Arch Repair

Background: Hybrid aortic arch repair with debranching of the supra-aortic vessels carries a high risk of cerebral infarction and fatal complications associated with side clamping of the ascending aorta. A previous study had reported the “real chimney” technique, a novel method for clamp-free total debranching thoracic endovascular aortic repair with the ascending aortic sleeve banding with dacron. In this study, we aim to build upon this foundation by presenting our experience with the early and midterm outcomes of this technique. Methods: We retrospectively reviewed the medical records of 61 consecutive older adult patients with aortic arch pathologies and a high risk of open repair who underwent total debranching thoracic endovascular aortic repair using the real chimney technique at our institution between January 2014 and June 2022. This technique was used to anastomose the ascending aorta with the main trunk of the triple-branched prosthetic graft. Results: The mean patient age was 75.1 years, and 54% of patients were transferred from medical facilities with cardiothoracic surgery departments. The comorbidities included chronic obstructive pulmonary disease (49.2%), chronic kidney disease (63.9%), coronary artery disease (27.9%), and history of stroke (31.1%). No 30-day mortality was observed. Complications included postoperative renal failure requiring permanent hemodialysis (4; 6.6%), stroke (modified Rankin scale score: ≥2 in 5; 8.2%), permanent paraplegia (1; 1.6%), and permanent paraparesis (4; 6.6%). The median follow-up period was 40.5±28.5 months. The postoperative survival rates at 5 years were 66.8%. No patients experienced complications associated with the aorta or anastomosis site; only 1 patient required an additional procedure for stenosis of the anastomosis site (midterm). An aneurysmal diameter reduction of ≥3 mm was observed in 37 cases (60.7%), and the mean aneurysmal diameter reduction was 5.3 mm. Conclusions: The postoperative outcome of total debranching thoracic endovascular aortic arch repair is not only acceptable but also promising, particularly in patients at high risk of open repair. Clinical Impact Our novel real chimney technique for total debranching thoracic endovascular aortic repair of aortic arch pathologies in patients who were at a high-risk for open repair resulted in no 30-day mortality and no complications related to the aorta or the real chimney anastomosis site. The real chimney technique is effective for managing aortic arch pathologies and enables less invasive total debranching thoracic endovascular aortic arch repair without the need for extracorporeal circulation and clamping of the ascending aorta

Primary Thoracic Endografting for T4 Lung Cancer Aortic Involvement

PurposeThe aim of the study was to present the results in patients with a T4 thoracic tumor with aortic involvement who were treated with a thoracic endograft before surgical resection. DescriptionAll consecutive patients undergoing a thoracic endograft procedure before an oncologic resection between January 2012 and December 2019 were reviewed in a single-center retrospective study. Included patients had either a T4 lung tumor or a mediastinal tumor invading the thoracic aorta. EvaluationNine patients were included: 7 with T4 lung cancer, 1 with sarcoma, and 1 patient with thymoma. Median follow-up was 25 months (range, 22-47 months). There were no endograft-related complications. All but 1 patient had an R0 oncologic resection. Eight patients were alive and free from recurrence at the last follow-up. ConclusionsUse of thoracic stent grafting before surgical resection for patients with a thoracic tumor invading the aorta is a feasible option that obviates the need for extracorporeal circulation and its associated morbidity. This technique could be an alternative strategy in the treatment of tumors invading the thoracic aorta.

Ácido láctico y asociación con la mortalidad en el posoperatorio de cirugía cardiaca. Estudio cohorte retrospectiva

ObjectiveTo analyse the behaviour of lactic acid in the first 24h after surgery in cardiac surgery, and conditions associated with its elevation and impact on clinical evolution as a factor associated with mortality. DesignObservational, analytical, retrospective cohort study, repeated measures. Scope4-Level clinical cardiovascular intensive care unit in Colombia. ParticipantsPatients over 18 years of age who were admitted to the intensive care unit in the postoperative period of cardiac surgery with the need for extracorporeal circulation. InterventionsMeasurement of lactic acid 0, 6, 12, 18 and 24h after surgery. Variable of interestLactic acid, mediastinal bleeding, extracorporeal circulation time, aortic clamp time, overall in-hospital mortality. ResultsA total of 214 people were included, the most frequent surgery was aortic change (43.9%), hypertension was present in 48.6% of the patients, the overall in-hospital mortality was 5.6%, the time of average hospital stay in ICU 3 days, during follow-up lactic acid was higher in those who died, with the greatest difference at 12h, with the variables that influence the change in lactic acid were aortic clamp time, mediastinal bleeding >1000cc, urea nitrogen and the use of two inotropes, the factors that increase the risk of mortality were lactic acid greater than 3mmol/l RR 13.96 CI 1.55–125.9; p-value=.019, and mediastinal bleeding >1000cc, RR: 2.55 (CI: 1.00-6.51), p-value=.049. ConclusionLactic acid was shown to be an associated factor for mortality at different times of monitoring, always higher in the people who died.

Contemporary techniques and outcomes of surgery for locally advanced renal cell carcinoma with focus on inferior vena cava thrombectomy: The value of a multidisciplinary team

ObjectiveTo report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma (RCC) treated at a referral academic centre, focusing on technical nuances and on the value of a multidisciplinary team. MethodsWe queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced (cT3-T4 N0-1 M0) renal masses suspected of RCC at our centre between January 2017 and December 2020. ResultsOverall, 32 patients were included in the analytic cohort. Of these, 12 (37.5%) tumours were staged as cT3a, 8 (25.0%) as cT3b, 5 (15.6%) as cT3c, and 7 (21.9%) as cT4; 6 (18.8%) patients had preoperative evidence of lymph node involvement. Nine (28.1%) patients underwent nephron-sparing surgery while 23 (71.9%) received radical nephrectomy. A template-based lymphadenectomy was performed in 12 cases, with evidence of disease in 3 (25.0%) at definitive histopathological analysis. Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation. While intraoperative complications were recorded in 3 (9.4%) patients, no postoperative major complications (Clavien-Dindo ≥3) were observed. At histopathological analysis, 2 (6.2%) patients who underwent partial nephrectomy harboured oncocytoma, while the most common malignant histotype was clear cell RCC (62.5%), with a median Leibovich score of 6 (interquartile range 5–7). ConclusionLocally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams. Our experience confirms that provided careful patient selection, surgery in experienced hands can achieve favourable perioperative, oncological, and functional outcomes.

Is the disability of elderly patients related to increased blood transfusions after cardiac surgery?

Abstract Funding Acknowledgements Type of funding sources: None. Intorduction. Perioperative bleeding occurs in 2 to 15% of patients. Cardiac surgeries are associated with perioperative blood loss due to the invasive nature of the procedures, the need for high doses of anticoagulation and the need for extracorporeal circulation. Both transfusions and reoperations due to excessive postoperative bleeding are associated with adverse clinical outcomes and increased costs of care. In 2017, the common position of the European Association of Cardiac Cancer Surgeons (EACTS) and the European Association of Cardiac Cancer Surgical Anesthesiologists (EACTA) regarding the management of patient blood in order to maintain adequate perioperative homeostasis and minimizing bleeding, and thus reducing the amount of blood transfusions. Advanced age is one of the factors associated with an increased risk of perioperative bleeding, including the need for transfusion and reoperation. Purpose. Assessment of the relationship between preoperative disability and the amount of blood transfused in elderly patients after cardiac surgeries. Methods. The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M ± SD =71.69 ± 4). A sociodemographic questionnaire and the Nagi scale for disability assessment were used to collect the research material. The Nagi scale assesses the limitations of the patient in seven activities. A significant disability is considered to be ≥ 3 points. The number of blood transfusions was assessed based on the analysis of medical records. The number of blood units transfused during hospitalization was taken into account. Statistically significant was assumed to be p < 0.05. Results. In the study group the mean score on the Nagi scale was M ± SD = 3.41 ± 1.83 points. Blood transfusions were required by 66% of the study participants. The number of transfused blood units ranged from 1 to 11. The mean number of transfused blood units was 1.41 ± 1.83 points: M ± SD = 1.56 ± 1.93. 28 patients required 1 blood unit, 11 blood units required 1 patient. There was a significant positive correlation between the values of the Nagi scale and the number of blood units transfused (r = 0.233, p = 0.019) . Moreover, the number of blood units transfused to patients with values of the Nagi scale ≥3 points turned out to be significantly higher than in patients with values of this scale <3 points (p = 0.015). Conclusions. 1) Patients with disability are qualified for cardiac surgeries. 2) Patients with disabilities require more blood units to be transfused.

Lung Transplantation in Cystic Fibrosis and the Impact of Extracorporeal Circulation

IntroductionLung disease is the major cause of death among cystic fibrosis (CF) patients, affecting 80% of the population. The impact of extracorporeal circulation (ECC) during transplantation has not been fully clarified. This study aimed to evaluate the outcomes of lung transplantation for CF in a single center, and to assess the impact of ECC on survival. MethodsWe performed a retrospective observational study of all transplanted CF patients in a single center between 1992 and 2011. During this period, 64 lung transplantations for CF were performed. ResultsFive- and 10-year survival of transplanted patients was 56.7% and 41.3%, respectively. Pre-transplantation supplemental oxygen requirements and non-invasive mechanical ventilation (NIMV) do not seem to affect survival (P=.44 and P=.63, respectively). Five- and 10-year survival among patients who did not undergo ECC during transplantation was 75.69% and 49.06%, respectively, while in those did undergo ECC during the procedure, 5- and 10-year survival was 34.14% and 29.87%, respectively (P=.001). PaCO2 is an independent risk factor for the need for ECC. ConclusionsThe survival rates of CF patients undergoing lung transplantation in our hospital are similar to those described in international registries. Survival is lower among patients receiving ECC during the procedure. PaCO2 is a risk factor for the need for ECC during lung transplantation.

El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea

IntroductionLung disease is the major cause of death among cystic fibrosis (CF) patients, affecting 80% of the population. The impact of extracorporeal circulation (ECC) during transplantation has not been fully clarified. This study aimed to evaluate the outcomes of lung transplantation for CF in a single center, and to assess the impact of ECC on survival. MethodsWe performed a retrospective observational study of all trasplanted CF patients in a single center between 1992 and 2011. During this period, 64 lung transplantations for CF were performed. ResultsFive- and 10-year survival of trasplanted patients was 56.7% and 41.3%, respectively. Pre-transplantation supplemental oxygen requirements and non-invasive mechanical ventilation (NIMV) do not seem to affect survival (P=.44 and P=.63, respectively). Five- and 10-year survival among patients who did not undergo ECC during transplantation was 75.69% and 49.06%, respectively, while in those did undergo ECC during the procedure, 5- and 10-year survival was 34.14% and 29.87%, respectively (P=.001). PaCO2 is an independent risk factor for the need for ECC. ConclusionsThe survival rates of CF patients undergoing lung transplantation in our hospital are similar to those described in international registries. Survival is lower among patients receiving ECC during the procedure. PaCO2 is a risk factor for the need for ECC during lung transplantation.

CArbon dioxide surgical field flooding and aortic NO-touch off-pump coronary artery bypass grafting to reduce Neurological injuries after surgical coronary revascularisation (CANON): protocol for a randomised, controlled, investigator and patient blinded single-centre superiority trial with three parallel arms

IntroductionNeurological injuries remain a major concern following coronary artery bypass grafting (CABG) that offsets survival benefit of CABG over percutaneous coronary interventions. Among numerous efforts to combat this issue is...

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report.

IntroductionTraditionally, tumor thrombi extending into the right atrium have been managed by open surgery with sternotomy, cardiopulmonary bypass circulation and hypothermic circulatory arrest, and are associated with significant morbidity and mortality rates. Here, we evaluate the results of cavoatrial thrombectomy using our own, Foley catheter assisted-technique, obviating the need for thoracotomy, extracorporeal circulation, and/or hypothermic circulatory arrest.Material and methodsBetween June 2013 and January 2015, 4 consecutive patients underwent cavoatrial thrombectomy performed with our own, Foley catheter assisted technique, via Chevron incision, with no need for extracorporeal circulation or hypothermy for renal cell carcinoma with tumor thrombus extending into the right atrium. Analyses of patients’ data from a prospectively maintained database with respect to perioperative characteristics, morbidity and mortality were performed.ResultsThe total mean duration of surgery was 255 minutes. The mean time of total IVC (inferior vena cava) occlusion was 90 seconds. The average blood loss volume, timed from the beginning of cavotomy incision until its closure, was 1200 ml. The total mean intraoperative blood loss was 3,150 ml. There was no perioperative death. Postoperative complications included one transient acute kidney injury requiring one-off hemodialysis and one re-operation due to bleeding. The follow-up time ranged between 12 to 17 months. None of the patients developed disease recurrence. All patients were still alive at the time of study completion.ConclusionsObtained results support the validity of our own, Foley catheter assisted technique, without cardiopulmonary bypass and hypothermic circulatory arrest for the treatment of renal cell carcinoma with tumor thrombus extending into the right atrium.

Of Mice and Men (and Effects of Gene Silencing)

In this issue of Circulation , Zheng and coworkers1 demonstrate the efficacy of specific small interfering RNAs (siRNAs) added to University of Wisconsin solution in protecting donor hearts against cold ischemic injury during storage and subsequent reperfusion. siRNAs targeted tumor necrosis factor-α, C3, and Fas. The study design was well rationalized and performed systematically to confirm the efficacy of these siRNA constructs in silencing their respective targets, first in cell culture and subsequently in whole mouse hearts. Quantitative polymerase chain reaction was used to demonstrate knockdown of each of these proteins after ischemia and reperfusion in contrast to their strong upregulation in control hearts. Beneficial effects were confirmed by enhanced function, decreased apoptosis, diminished neutrophil activation and infiltration, and less histological evidence of tissue damage in the treated hearts. Article see p 1099 First discovered as a method for gene silencing in plants, siRNA effectively silences or reduces posttranscriptional efficacy of …

Early Activation of Patients after Surgery for Coronary Heart Disease under Extracorporeal Circulation

Objective: to analyze the safety and clinical efficiency of early activation of patients operated on for coronary heart disease under extracorporeal circulation. Subjects and methods. The data available in the case histories of 673 patients aged 29—76 years, operated on in 1995, 2004, and 2006, were analyzed. The study excluded patients with severe intraoperative complications (acute myocardial infarction, a need for extracorporeal circulation, and surgical bleeding). Early activation was made on an operating table if there were no contraindications. Some sections of the study were performed in the matched patient groups. Results. With early activation, the dosages of fentanyl were reduced by 2.5-3 times as compared with the 1995 data; the use of ketamine and diazepam was stopped. Instead of the latter, the currently available inhalational agents are coming into use: midazolam has been introduced and the rate of propofol use has increased. The higher activation rate required the use of flumazenil, naloxone, and proserin. The goal-oriented study of central hemodynamics with emphasis on early activation has indicated that lower dosages of fentanyl have no negative impact on cardiac pump function or myocardial oxygen balance. When the trachea was extubated on the operating table, there was appropriate central hemodynamic stabilization. It was found that the incidence of postoperative myocardial infarctions did not depend on the rate of activation. The frequency of cardiovascular complications was 38.8±5.9% and 22.9±5.0% in the prolonged artificial ventilation (AV) and early activation groups, respectively (p<0.05); that of pulmonary complications was 16.4±4.5% and 5.7±2.8%, respectively (p<0.05). Early activation halved the length of stay at an intensive care unit (p<0.05) and reduced postoperative hospitalization at surgery units by 5 days (p< 0.05). Introduction of early activation caused a decrease in the duration of postoperative AV in the patients, inactivated in the operating-room, from 16±1 hours (in 1995) to 7±1.2 hours (in 2006). Conclusion. The results of the goal-oriented studies, as well as the analysis of an array of clinical data suggest that early activation after myocardial revascularization under extracorporeal circulation is a safe and clinically effective methodological approach to anesthetic and intensive care management in cardiac surgical patients with coronary heart disease. Key words: early activation, myocardial revascularization, operations under extracorporeal circulation, tracheal extubation in the operating-room.

Prognostic Factors Influencing Survival Rates in Children Following Lung Transplantation

Objectives To assess the results of lung transplantation (LT) in children under 17 years of age and identify factors affecting long-term survival. Methods A retrospective review was performed of 37 patients (<17 years) who had received a lung transplant between 1996 and 2007. Morbidity, mortality, and survival were analyzed by the Kaplan-Meier method and the log-rank test. Results There were 37 LTs: 30 bilateral, four lobar, two liver-lung, one unilateral. Indications for transplantation were: cystic fibrosis ( n = 30), pulmonary fibrosis ( n = 1), bronchiectasis ( n = 1), Kartagener's syndrome ( n = 1), bronchiolitis obliterans ( n = 3), and pulmonary fibrosis due to radiotherapy-chemotherapy ( n = 1). The intubation time and oxygenation index of donors were 49 ± 36 hours and 455 ± 83.5 mm Hg, respectively. Seventeen patients needed extracorporeal circulation (ECC) and 13 were coded as priorities. High blood pressure and renal failure were the most frequent complications. Overall survival rates were 65.7%, 59.4%, 56.1%, 44.5%, and 39.6% at 1, 2, 3, 5, and 10 years, respectively. Need for ECC ( P = .001), surgical complications ( P = .037), oxygenation index <450 mm Hg ( P = .005), OLT in priority code ( P = .04), and age of donor >16 years ( P = .005) were associated with poor survival. Conclusions LT is an appropriate procedure for certain types of end-stage pediatric pulmonary pathologies, achieving acceptable long-term survival rates. When the procedure is carried out under a surgical priority code, it is associated with a high rate of perioperative morbidity and mortality and poorer long-term survival. Other factors that have a negative influence on survival include the need for ECC, surgical complications, an oxygenation index <450 mm Hg, and donor age >16 years.

Bilateral Lung Transplantation in Asymmetric Thorax: Case Reports

Suppurative lung diseases, such as cystic fibrosis and bronchiectasis, when diffuse and associated with important functional loss, can be treated with bilateral lung transplantation with good results. These diseases are frequently associated with previous lung resections presenting an asymmetric thorax, thus making lung extraction difficult and generating disproportion between the graft and the pleural cavity. To treat this condition, pneumonectomy and single lung transplantation is a feasible option; however, there are associated comorbidities and an invariable need for extracorporeal circulation. Described herein are 2 patients with an asymmetric thorax, treated with bilateral transplantation and lung volume reduction with lobectomy.

Off-Pump Repair of a Giant Pseudoaneurysm of a Distal Saphenous Vein Bypass Graft

Pseudoaneurysm of a saphenous vein bypass graft is a rare occurrence after coronary artery bypass grafting but may have lethal consequences. We treated a giant pseudoaneurysm of a saphenous vein graft to the right coronary artery in an 80-year-old male Jehovah's Witness who had undergone coronary artery bypass grafting 4 and a half years earlier. His history revealed a recurrent sternal wound infection. By using a venous patch to close the damaged graft, we were able to perform a successful surgical repair without the need for extracorporeal circulation.

A Less Invasive Approach to Completely Repair the Aortic Arch

Surgical replacement of the aortic arch is an established procedure that requires cardiopulmonary bypass and deep hypothermic circulatory arrest. However, this approach is associated with major perioperative risks. The significant risks associated with conventional open repair of the thoracic aorta are the main argument for less invasive strategies. We present a less invasive surgical and endovascular approach that allows total exclusion of the aortic arch without the need for extracorporeal circulation, deep hypothermia, and circulatory arrest. All procedures were successful, and the patients recovered without neurologic, cardiac, or bleeding complications. Arteriography confirmed proper position of the stent graft and complete exclusion of the lesion at the end of the procedure. One patient had an endoleak type I and underwent successful additional retrograde stent-graft placement over the proximal landing zone 3 weeks after the initial procedure. Clinical follow-up (between 8 and 18 months) was fully uncomplicated in all patients. Computed tomographic scan at 6 months demonstrated complete exclusion of the arch lesion in all cases and did not reveal any endoleaks. Assuming that technical refinements may improve all steps of the endovascular intervention, this combined approach may turn out to be the preferred therapeutic modality to repair aortic arch lesions in patients with multiple comorbidities who otherwise would not be candidates for a conventional operative repair. However, long-term observation is necessary to confirm the stability of this type of repair.

New strategies to control the inflammatory response in cardiac surgery

To present and interpret data from recent clinical studies (July 2002-August 2003) of strategies to control the inflammatory response after cardiac surgery. Off-pump coronary artery bypass techniques, which avoid the need for extracorporeal circulation, attenuate the inflammatory response and appear to confer clinical benefit. Concerns regarding the quality of the revascularization after off-pump coronary artery bypass appear to have been allayed. At present, ventricular assist devices do not enhance the efficacy of off-pump coronary artery bypass. In patients undergoing cardiopulmonary bypass, heparin-coated circuits, hypothermic pulmonary perfusion, normoxic reperfusion after aortic unclamping, and modified ultrafiltration hold promise. Strategies to maintain perioperative haemodynamic stability, such as enoximone therapy, may be beneficial, particularly in elderly patients. Aprotinin may have important beneficial anti-inflammatory actions in higher-risk adult and paediatric patients. The therapeutic potential of corticosteroids, particularly when administered in multiple dosages is increasingly clear. Direct anti-mediator therapies that focus upon key effector molecules and pathways of the inflammatory response offer future therapeutic options. The potential for strategies that inhibit the inflammatory response to improve outcome after cardiac surgery is clear. Large-scale multicentre trials investigating the most promising strategies, including off-pump coronary artery bypass, heparin-coated circuits, and perioperative corticosteroid and aprotinin therapy, are urgently needed. These trials need to be restricted to the high-risk patient groups most likely to experience benefit. In the interim, the optimal strategy to minimize the inflammatory response to cardiac surgery will remain elusive.

Characterization of the natural history of cervical heterotopic heart transplantation with echocardiography

Background Limitations of the dog model of orthotopic heart transplantation to study rejection include the need for extracorporeal circulation and transfusions. Heterotopic cervical heart transplantation may improve on these limitations. It is not known whether the natural history after heterotopic transplant is similar to that after orthotopic grafting. Methods Twenty-one dogs underwent cervical heterotopic heart transplantation. Serial echocardiographic studies were performed 1 to 3 hours after surgery, at 24 hours, 48 hours later, and immediately before killing (5 to 7 days). Results LV diastolic and systolic areas were elevated immediately after transplantation (4.95 ± 1.49 cm 2 and 3.36 ± 1.18 cm 2 respectively) but decreased at 24 hours (3.93 ± 1.20 cm 2, p = 0.0003 and 2.44 ± 0.96 cm 2, p = 0.16). Thereafter, a progressive increase in LV diastolic and systolic areas was observed until sacrifice (5.53 ± 2.20 cm 2 and 4.59 ± 2.14 cm 2, p < 0.001 vs 24 hours). LV fractional area shortening (FAS) and fractional volume change were depressed immediately after transplantation (28.2 ± 12.8% and 40.4 ± 12.3%, respectively), but increased at 24 hours (35.7 ± 10.0%, p = 0.11 and 50.3 ± 4.0%, p = 0.02). FAS decreased at 48 hours to 19.6 ± 11.1% ( p = 0.01 vs 24 hours). The centractility indexes were markedly reduced before killing (FAS = 14.0 ± 8.2% and LVEF = 18.4 ± 1.3%, p < 0.0005 vs 24 hours). The thickness of the interventricular septum increased from 11.9 ± 2.0 mm at baseline to 14.4 ± 4.2 mm before sacrifice ( p = 0.007). Conclusion The evolution of dogs after heterotopic cervical heart transplant is comparable to that after the more standard orthotopic graft. Considering its multiple practical advantages including the easy echocardiographic follow-up, heterotopic transplantation may become a very practical model to use for the study of rejection after heart transplantation.

Experimental model of heterotopic cardiac transplantation for evaluation of graft viability and function.

An experimental model of heterotopic intrathoracic cardiac transplantation making possible an evaluation of graft viability and function has been studied. The technique requires only two anastomoses in the normothermic state without cardiopulmonary bypass. In this model, the ascending aorta of the recipient animal may be occluded completely, enabling an increasing preload on the graft. In case of adequate myocardial preservation of the cardiac graft, the aorta may be completely occluded and the recipient systemic circulation can be sustained by the graft. However, in case of inadequate graft myocardial function, or in case of size mismatch, the recipient heart alone contributes to the circulation. This technique appears quite useful because of its simplicity, the elimination of the need for extracorporeal circulation while allowing a functional evaluation following cardiac graft preservation.