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.