First “Never-Stop Beating” Heart Transplant Marks a Historic Medical Breakthrough

For the first time, surgeons have successfully performed a heart transplant in which the donor heart continued beating throughout the entire procedure, significantly reducing the potential damage often associated with this complex operation. This innovation marks a major milestone and could pave the way for a new era of more effective heart transplants.

The groundbreaking surgery was carried out by a team at National Taiwan University Hospital (NTUH) in Taipei. In this unprecedented approach, the donor heart remained active from removal through to implantation in the recipient. Traditionally, the heart is removed and preserved in cold storage to reduce its metabolic activity, resulting in a period without blood flow known as “ischemic time.” This stage poses a risk of damage to the heart and increases the likelihood of rejection post-transplant.

Understanding Ischemic Damage

When deprived of blood flow, the heart experiences ischemia – a lack of oxygen – which can harm the heart muscle (myocardium), affecting its function after the transplant.Even when doctors keep the ischemic time to just a few hours, it can still cause significant damage.

To eliminate this risk, the NTUH team performed a zero-ischemic-time transplant, keeping the heart beating continuously between donor and recipient.

Our goal was to carry out a transplant without any ischemic time, so the heart wouldn’t have to stop, and we could prevent the typical injury that happens after reperfusion, said Chi Nai-hsin, a physician at the hospital’s Cardiovascular Center, during a press conference held on April 16.

The hospital team developed a specially designed organ care system that made this achievement possible.Known as the NTUH organ care system (OCS), it keeps the heart beating with oxygen-rich blood throughout the entire process.The team inspired the system by extracorporeal membrane oxygenation (ECMO), a life support technology that assists heart and lung function.

The team connected the heart to this system and moved it from one operating room to another—without missing a single beat.

Doctors discharged the 49-year-old woman with dilated cardiomyopathy shortly after her surgery, which took place last August. Follow-up visits showed that her levels of cardiac enzymes—typically elevated when heart muscle injury occurs—remained low, signaling a smooth recovery.

Chi said, “We’ve proven the safety and feasibility of this surgery,” and added that the team successfully performed a second transplant using the same method earlier this year.

A New Direction for Future Transplants

So far, NTUH has performed around 700 heart transplants.The team now hopes to perform more future procedures using the OCS, completely avoiding ischemic time.

It’s worth noting that Stanford University also published studies in 2023 and 2024 detailing similar beating-heart transplant procedures. However, in those cases, the medical teams allowed the hearts to undergo brief periods of ischemia (10 to 30 minutes) before they connected them to the support system.

In both of NTUH’s procedures, the hearts were still beating before procurement, continued beating after procurement, and never stopped – achieving zero ischemic time, said Chen Yih-shurng, head of the hospital’s Organ Transplant Team.

The team plans to continue refining the procedure and advancing organ preservation technology, so even more patients can benefit from zero-ischemic-time heart transplants in the future.

Read the original article on: New Atlas

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