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Heart transplantation is the gold standard treatment for advanced heart failure in selected patients. Organ shortage is however a major concern, leading transplant teams to expand the criteria for donor selection. Organ retrieval is routinely performed nowadays in donors older than 55 years, with impaired left ventricular function and/or hypertrophy, or after prolonged cardiac arrest such as after circulatory-determined death. All these conditions are associated with an increased high of primary graft failure, the main cause of early death after heart transplantation. Machine preservation technology has been recently applied to allow for extended preservation of the donor heart. Compared to conventional static cold storage, this approach can also provide viability assessment of the donor heart before transplant, especially in case of ex situ normothermic blood perfusion. After a brief review of currently available preservation machines, we sought to describe different approaches for assessment of the donor heart using ex situ organ perfusion, from metabolic monitoring to cardiac imaging and hemodynamic investigations.
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