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Resumen La miocarditis es una enfermedad inflamatoria del tejido cardíaco de etiología variable, infecciosa o no in fecciosa. Su presentación va desde formas asintomáticas hasta fulminantes. Se presenta el caso de un varón de 24 años, con antecedente de hepatitis autoinmune, en fase cirrótica compensada. Consultó por disnea de 15 días de evolu ción. Presentó cuadro gastrointestinal un mes previo a la consulta. El examen físico reveló signos de sobrecarga hídrica. El laboratorio informó elevación de biomar cadores cardiacos, insuficiencia hepática aguda sobre crónica y graves trastornos de coagulación. Se realizó un ecocardiograma transtorácico que evidenció disfunción biventricular grave global, con adelgazamiento de las paredes. Las hipótesis diagnósticas fueron compromiso cardíaco por reactivación de enfermedad autoinmu ne versus miocarditis viral. Se realizó una resonancia magnética que confirmó la disfunción ventricular grave en la que se observó realce tardío de gadolinio suges tivo de miocarditis. Se indicó tratamiento con pulsos de metilprednisolona. El primer día de la internación evolucionó con signos de shock cardiogénico y arritmia ventricular refractaria al tratamiento. Posteriormente a una evaluación multidisciplinaria exhaustiva y dificulto sa por el estado clínico, se planteó la posibilidad de un trasplante cardiaco. Se instauró soporte con membrana de oxigenación extracorpórea (ECMO) como puente al trasplante. Al séptimo día de colocado el ECMO, y luego de gran mejoría de los parámetros del hepatograma, recibió un trasplante cardíaco. Tuvo buena evolución postoperatoria, sin embargo, a los dos meses falleció por una infección oportunista. Los resultados de la biopsia del órgano explantado confirmaron el diagnóstico de miocarditis linfocítica.
Abstract Myocarditis is an inflammatory disease of the cardiac tissue of variable etiology, both infectious and non-in fectious. Its presentation can range from asymptomatic to fulminant forms. We present the case of a 24-year-old male patient with a history of autoimmune hepatitis in compensated cirrhotic phase. He consulted for dyspnea of 15 days evolution. He had presented gastrointestinal symptoms one month prior to the consultation. Physical examina tion revealed signs of heart failure. Laboratory examina tion showed elevated cardiac biomarkers and acute on chronic hepatic insufficiency. A transthoracic echocar diogram showed severe global biventricular dysfunction. The diagnostic hypotheses were cardiac involvement due to reactivation of autoimmune disease versus viral myocarditis. An MRI was performed which confirmed very severe ventricular dysfunction and late gadolinium enhancement suggestive of myocarditis. It was indicated treatment with methylprednisolone pulses. On the first day of hospitalization he evolved with clear signs of car diogenic shock and ventricular arrhythmia refractory to medical treatment. After an exhaustive multidisciplinary evaluation, which was difficult due to his clinical condi tion, the possibility of a heart transplant was considered. Extracorporeal membrane oxygenation (ECMO) support was established as a bridge to transplantation. On the seventh day after ECMO, and after great improvement of the hepatogram parameters, the patient received a heart transplant. He had good postoperative evolution. However, he died two months after the transplant due to an opportunistic infection. The results of the biopsy of the explanted organ confirmed the diagnosis of lym phocytic myocarditis.
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ABSTRACT Objective: Pediatric cardiac tumors are rare and, among them, 90% are benign. Cardiac fibroma is the second most frequent tumor, after rhabdomyoma. The objective of this study is to report a case of cardiac fibroma diagnosed incidentally in a patient admitted with acute viral bronchiolitis. Case description: A 5-month-old male infant was admitted to the pediatric emergency department with acute viral bronchiolitis requiring hospitalization. He presented a detectable respiratory syncytial virus in oropharyngeal swab, blood test with lymphocytosis and a chest radiography revealed cardiomegaly. Further cardiologic testing was performed detecting elevation of cardiac biomarkers, an electrocardiogram with alteration of left ventricular repolarization and echocardiogram with a heterogeneous mass in the left ventricular, with areas of calcification. A chest angiotomography suggested rhabdomyosarcoma or cardiac fibroma and a magnetic resonance showed a mass, with characteristics suggesting fibroma. The final diagnosis was made after two cardiac catheterizations for biopsy of the lesion, confirming cardiac fibroma by anatomopathological examination. Because the patient had moderate to severe systolic dysfunction, he was submitted to heart transplant. Comments: One third of cardiac fibromas are asymptomatic, generally diagnosed late through tests ordered for other reasons. The gold-standard test for definitive diagnosis is biopsy. Cardiac fibroma usually does not present spontaneous regression and, in most cases, partial or total surgical resection is necessary. When tumors are unresectable, heart transplantation should be indicated. It is essential to have detailed characterization of the cardiac mass to establish the most appropriate therapeutic approach for each patient.
RESUMO Objetivo: Tumores cardíacos pediátricos são raros e, entre eles, 90% são benignos. O fibroma cardíaco é o segundo mais frequente, após o rabdomioma. O objetivo deste trabalho é relatar um caso de fibroma cardíaco, cujo diagnóstico foi incidental em um paciente internado por bronquiolite viral aguda. Descrição do caso: Lactente do sexo masculino com cinco meses foi atendido em um pronto atendimento pediátrico com quadro de bronquiolite viral aguda, necessitando de hospitalização. Em exames complementares, apresentou vírus sincicial respiratório detectável, hemograma com linfocitose, além de radiografia de tórax com cardiomegalia. Em investigação cardiológica, as enzimas cardíacas encontravam-se elevadas, o eletrocardiograma apresentava alteração de repolarização de parede lateral de ventrículo esquerdo e o ecocardiograma demonstrou massa heterogênea em ventrículo esquerdo, com áreas de calcificação. A angiotomografia de tórax sugeriu rabdomiossarcoma ou fibroma cardíaco e a ressonância magnética demonstrou massa cuja localização e características sugeriram fibroma. O diagnóstico foi conclusivo após dois cateterismos para biópsia da lesão, confirmando fibroma cardíaco pelo anatomopatológico. Em razão da disfunção sistólica moderada a grave, o paciente foi submetido a transplante cardíaco. Comentários: Um terço dos fibromas cardíacos é assintomático, geralmente diagnosticado tardiamente por meio de exames solicitados por outro motivo. O padrão-ouro para o diagnóstico definitivo é a biópsia. O fibroma cardíaco não costuma apresentar regressão espontânea, sendo submetido, na maioria dos casos, a ressecção cirúrgica parcial ou total. Nos tumores irressecáveis, o transplante cardíaco deve ser indicado. A caracterização detalhada da massa cardíaca é fundamental para traçar a conduta terapêutica mais adequada para cada paciente.
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Abstract Objective: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy Methods: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. Results: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). Conclusion: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.
Resumen Objetivo: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. Métodos: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. Resultados: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). Conclusión: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.
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Resumen El 21 de julio de 1988, en México se realizó con éxito el primer trasplante de corazón; 34 años después, diversos centros hospitalarios del país efectúan este procedimiento. Aquí se presenta información y comentarios de los resultados obtenidos en este periodo en el Hospital General "Dr. Gaudencio González Garza", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, donde se han llevado a cabo 234 trasplantes (uno de cada tres efectuados en el país), con una supervivencia a corto y mediano plazo equiparable a la reportada en el resto del mundo. Ese hospital es el único centro que realiza trasplante simultáneo de corazón-riñón y retrasplante cardiaco electivo, con resultados favorables.
Abstract On July 21, 1988, a successful heart transplant was carried out for the first time in Mexico; 34 years later, several hospitals in the country have performed this procedure. We present information and comments on the results obtained within this period at Mexican Social Security Institute La Raza National Medical Center "Dr. Gaudencio González Garza" General Hospital, where 234 transplants have been performed (one out of every three carried out throughout the country), with a short- and mid-term survival comparable to that reported in the rest of the world. This hospital is the only center that performs simultaneous heart-kidney transplantation and elective heart re-transplantation, with favorable results.
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Abstract Background: Demand for donor hearts and lungs exceeds their supply. Extended Criteria Donor (ECD) organs are used to help meet this demand, but their impact on heart-lung transplantation outcomes is poorly characterized. Methods and results: The United Network for Organ Sharing was queried for data on adult heart-lung transplantation recipients (n = 447) from 2005‒2021. Recipients were stratified based on whether they received ECD hearts and/or lungs. Morbidity was analyzed using Kruskal-Wallis, chi-square, and Fisher's exact tests. Mortality was analyzed using Kaplan-Meier estimation, log-rank tests and Cox regression. Sixty-five (14.5%) patients received two ECD organs, 134 (30.0%) received only an ECD lung, and 65 (14.5%) only an ECD heart. Recipients of two ECD organs were older, more likely to have diabetes, and more likely transplanted from 2015‒2021 (p < 0.05). Groups did not differ by pre-transplant diagnosis, intensive care unit disposition, life support use, or hemodynam-ics. Group five-year survival rates ranged from 54.5% to 63.2% (p = 0.428). Groups did not differ by 30-day mortality, strokes, graft rejection, or hospital length of stay. Conclusions: Using ECD hearts and/or lungs for heart-lung transplantation is not associated with increased mortality and is a safe strategy for increasing donor organ supply in this complex patient population.
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ABSTRACT Introduction: The aims of this study were to determine the incidence of severe and moderate primary graft dysfunction (PGD) in our center, to identify, retrospectively, donors' and recipients' risk factors for PGD development, and to evaluate the impact of PGD within 30 days after heart transplantation. Methods: Donors' and recipients' medical records of 64 consecutive adult cardiac transplantations performed between January 2016 and June 2017 were reviewed. The International Society for Heart and Lung Transplantation (ISHLT) criteria were used to diagnose moderate and severe PGD. Associations of risk factors for combined moderate/severe PGD were assessed with appropriate statistical analyses. Results: Sixty-four patients underwent heart transplantation in this period. Twelve recipients (18.7%) developed severe or moderate PGD. Development of PGD was associated with previous donor cardiopulmonary resuscitation and a history of prior heart surgery in the recipient (P=0.01 and P=0.02, respectively). The 30-day in hospital mortality was similar in both PGD and non-PGD patients. Conclusion: The use of the ISHLT criteria for PGD is important to identify potential risk factor. The development of PGD did not affect short-term survival in our study. More studies should be done to better understand the pathophysiology of PGD.
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Objective:To investigate the application of extracorporeal membrane oxygenation(ECMO)bridging heart transplantation in critically ill children.Methods:The clinical data of two cases of critical infants with venous-arterial ECMO(VA-ECMO)bridging heart transplantation and literature review were retrospectively analyzed.Results:Two cases received orthotopic heart allograft with VA-ECMO support, and were discharged uneventfully without significant postoperative complications.On the 13th day of ECMO assistance, the first child was treated with orthotopic heart transplantation in a hospital qualified for heart transplantation, and the ECMO was evacuated during the operation.After 21 days of the heart transplantation, the patient was discharged from the hospital.The patient was followed up to be healthy after heart transplantation, and had the same development as children of the same age, and had been taking anti-rejection drugs for a long time.On the 10th day of VA-ECMO treatment, the second case received awake ECMO after cardiac function improved.On the 12th day of VA-ECMO treatment, the patient was successfully evacuated from VA-ECMO and waited for heart transplantation.Cardiac orthotopic transplantation was performed after the 17 days after VA-ECMO evacuation.The patient was transferred to the general ward after 6 days of hospitalization in the intensive care unit, and was discharged 23 days after transplantation with conventional anti-rejection therapy.Discharge follow-up in good health, normal school life.Conclusion:When VA-ECMO cannot be withdrawn from the heart of the critically ill children and the end-stage heart, VA-ECMO bridging heart transplantation should be selected at the right time for the children who meet the indications for heart transplantation to create survival opportunity for the previously hopeless children, save the life of the end-stage children, and improve the quality of life.
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Objective To analyze clinical prognosis, risk factors and predictive indexes of hyperkalemia in recipients after heart transplantation. Methods Clinical data of 158 recipients were retrospectively analyzed. According to the serum potassium levels within postoperative 1-year follow-up, all recipients were divided into the normal serum potassium level group (n=83), hyperkalemia group (n=43) and severe hyperkalemia group (n=32). The incidence and prognosis of hyperkalemia after heart transplantation were summarized. The risk factors and predictive indexes of hyperkalemia after heart transplantation were identified. Results The incidence of hyperkalemia and severe hyperkalemia within postoperative 1 year was 47.5%(75/158) and 20.3%(32/158), respectively. In the severe hyperkalemia group, the fatality was 16%(5/32), higher than 8%(7/83) in the normal serum potassium level group and 7%(3/43) in the hyperkalemia group. The mean serum creatinine (Scr) within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d were the independent risk factors for hyperkalemia following heart transplantation (all P < 0.05). The mean Scr level within 6 months before heart transplantation, postoperative hemodialysis time, and Scr levels at postoperative 1 and 7 d could be used to predict postoperative severe hyperkalemia. Conclusions The recipients with severe hyperkalemia after heart transplantation obtain poor prognosis. The mean Scr level within 6 months before heart transplantation, the final total bilirubin level before heart transplantation, postoperative hemodialysis time, and the Scr level and N-terminal pro-brain natriuretic peptide level at postoperative 1 d are the independent risk factors for hyperkalemia after heart transplantation. Perioperative Scr level and postoperative hemodialysis time may be used to predict the incidence of severe hyperkalemia within 1 year after heart transplantation.
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Objective To evaluate the effect of preoperative pulmonary artery pressure on perioperative prognosis of the recipients with end-stage heart failure undergoing heart transplantation. Methods Clinical data of 105 recipients receiving heart transplantation were retrospectively analyzed. The mean pulmonary artery pressure (mPAP) was used as the diagnostic criterion. The optimal cut-off value of mPAP for predicting perioperative prognosis of heart transplant recipients was determined. According to the optimal cut-off value of mPAP, all recipients were divided into the low mPAP group (n=66) and high mPAP group (n=39). Intraoperative indexes (cardiopulmonary bypass time, aortic occlusion time, assisted circulation time and cold ischemia time of donor heart) and postoperative indexes [intra-aortic balloon pump (IABP) support rate, IABP support time, extracorporeal membrane oxygenation (ECMO) support rate, ECMO support time, mechanical ventilation time, length of ICU stay, incidence of moderate and severe tricuspid regurgitation and perioperative mortality rate] were compared between the low and high mPAP groups. The prognosis of the two groups was compared. Results The optimal cut-off value of mPAP in predicting clinical prognosis of heart transplant recipients was 30.5 mmHg. In the high mPAP group, the ECMO support rate and perioperative mortality rate were higher than those in the low mPAP group (both P < 0.05). No significant differences were observed in the cardiopulmonary bypass time, aortic occlusion time, assisted circulation time, cold ischemia time of donor heart, IABP support rate, IABP support time, ECMO support time, mechanical ventilation time, length of ICU stay and incidence of moderate and severe tricuspid regurgitation between two groups (all P > 0.05). No significant differences were noted in the 1-, 2-, 3- and 4- survival rates between two groups (all P > 0.05). Conclusions Preoperative mPAP in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off value of mPAP in predicting perioperative prognosis of heart transplant recipients is 30.5 mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.
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Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on early allograft dysfunction (EAD) after heart transplantation. Methods Clinical data of 614 heart transplant recipients were retrospectively analyzed. All recipients were divided into the ECMO group (n=43) and non-ECMO group (n=571) according to postoperative application of ECMO. In the ECMO group, the conditions of recipients undergoing ECMO after heart transplantation were summarized. Perioperative status and long-term prognosis of recipients were compared between two groups. Results Among 43 recipients undergoing ECMO, 17 cases underwent thoracotomy due to bleeding, 10 cases of infection, 4 cases of venous thrombosis of the lower limbs, and 1 case of stroke, respectively. Twenty-six recipients were recovered and discharged after successful weaning from ECMO, six died during ECMO support, six died after weaning from ECMO, five received retransplantation due to unsuccessful weaning from ECMO, and only one survived after retransplantation. Compared with the non-ECMO group, intraoperative cardiopulmonary bypass duration was significantly longer, the proportion of recipients requiring postoperative intra-aortic balloon pump (IABP), dialysis due to renal insufficiency, reoperation for hemostasis, infection, mechanical ventilation time≥96 h and tracheotomy was significantly higher, and the length of postoperative intensive care unit (ICU) stay was significantly longer in the ECMO group (all P < 0.05). The survival rate after discharge and 90-d survival rate in the ECMO group were 63% and 96%, significantly lower than 97% and 100% in the non-ECMO group (both P < 0.05). Survival analysis showed that the long-term survival rate in the ECMO group was significantly lower than that in the non-ECMO group (P < 0.05). After excluding the recipients who died within 90 d after heart transplantation, no significant difference was observed in the long-term survival rate (P > 0.05). Conclusions ECMO is an effective treatment of EAD after heart transplantation. The short-term survival rate of recipients using ECMO after heart transplantation is lower than that of those who do not use ECMO, and there is no significant difference in long-term survival of recipients surviving 90 d after heart transplantation.
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At present, heart transplantation is the most effective treatment for end-stage heart failure. Nevertheless, the shortage of donors is becoming an increasingly severe challenge. In recent years, rapid development of mechanical circulatory support technologies has provided multiple therapeutic options for patients with end-stage heart failure. As an important mechanical circulatory support device, ventricular assist device (VAD) are divided into durable VAD (dVAD) and temporary VAD (tVAD) according to the duration of assistance. dVAD shows application potential in bridging heart transplantation, destination therapy and bridge to decision. With technological progress and experience accumulation in clinical application, VAD is evolving towards the direction of more biocompatible, lighter, more bionic and intelligent. In this article, the development of VAD, application status at home and abroad and the overall application of VAD in our hospital were reviewed, aiming to provide reference for promoting the clinical application of VAD in China.
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Pediatric heart transplantation is the standard treatment for children complicated with refractory heart failure which is difficult to be treated by conventional surgery or drugs. At present, an increasing quantity of pediatric heart transplantation is being performed worldwide, whereas relevant experience is still lacking in China. In recent 10 years, significant progress has been achieved in pediatric heart transplantation. On one hand, the number of pediatric heart transplantation has been increased year by year. On the other hand, ABO-incompatible heart transplantation, application of ventricular assist device in children, and recipient-donor weight mismatch transplantation have been widely employed to resolve the shortage of donor heart in pediatric heart transplantation. However, relevant experience of pediatric heart transplantation is lacking in China, especially in understanding the indications of pediatric heart transplantation and the application of specific strategies for pediatric heart transplantation, etc. In this article, the development history, advances in therapeutic strategy and clinical prognosis of pediatric heart transplantation were reviewed.
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Extracorporeal membrane oxygenation (ECMO) could pump the blood from human veins to the outside of the body, oxygenate the red blood cells in an artificial environment and then return them back into the body. ECMO could replace the heart and lungs to complete gas exchange and systemic blood perfusion in patients with severe cardiopulmonary insufficiency, which also plays an important role in the field of heart transplantation. Besides circulatory support treatment after heart transplantation, ECMO may also be used to prolong the waiting time for heart transplantation in patients with respiratory and circulatory failure before operation, as a bridging therapy for heart transplantation. However, at present, the application of ECMO in pediatric heart transplantation still exist challenges, such as high perioperative mortality and difficulty in determining the timing of treatment, etc. In this article, the development history of ECMO application in pediatric heart transplantation, use of ECMO before and after pediatric heart transplantation, ECMO-related complications in children, and application of ventricular assist device (VAD) in pediatric heart transplantation were briefly reviewed, aiming to provide reference for promoting the application of ECMO in pediatric heart transplantation.
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At present, the heart of donor from donation after brain death are the primary organ sources for heart transplantation. After brain death, severe hemodynamic changes and a series of organ functional changes will occur, thereby leading to the functional damage or even loss of tissues and organs, especially the heart. Intimate relationship and interaction have been found in the physiology and pathophysiology between nervous and cardiovascular systems. After stroke, autonomic nervous disorder, neuroendocrine disorder and intense and persistent inflammatory reaction could be caused by the brain-heart axis reaction, leading to stroke-induced cardiac injuries, such as sympathetic storm, catecholamine storm, inflammatory storm, etc. In this article, research progresses on the mechanism of myocardial injury in heart from donors with stroke and the effect on clinical efficacy and prognosis after heart transplantation were reviewed, aiming to provide reference for clinical practice and subsequent research.
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Heart transplantation is the primary therapeutic option for patients with end-stage heart failure. The shortage of donors has been the main limiting factor for the increasing quantity of heart transplantation. With persistent updating and introduction of novel technologies, the donor pool has been increasingly expanded, such as using the heart from older donors, donors infected with hepatitis C virus, donors dying from drug overdose or donation after cardiac death (DCD) donors, etc. Meantime, the proportion of recipients with advanced age, multiple organ dysfunction, mechanical circulatory support and human leukocyte antigen antibody sensitization has been significantly increased in recent years. The shortage of donors, complication of recipients' conditions, individualized management of immunosuppressive therapy and prevention and treatment of long-term cardiac allograft vasculopathy are all challenges in the field of heart transplantation. In this article, novel progresses on donor pool expansion, improving the quality of recipients, strengthening the diagnosis and treatment of rejection, and preventing cardiac allograft vasculopathy were reviewed, aiming to prolong the survival and enhance the quality of life of patients with end-stage heart failure on the waiting list or underwent heart transplantation.
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With gradual maturity of surgical technique of heart transplantation, extensive use of immunosuppressants and the improvement of organ distribution system, the shortage of donor heart has become a bottleneck issue restricting the development of heart transplantation in clinical practice. How to expand the donor pool for heart transplantation remains to be urgently solved. In recent years, with the development of science and technology and the application of new technology, groundbreaking progresses have been made on how to expand the donor pool for heart transplantation within the transplantation community. Multiple research results have been gradually translated into clinical practice, driving the development of heart transplantation in clinical settings. In this article, the latest technologies and strategies to expand the donor pool for heart transplantation were reviewed, the roles of organ preservation technology, use of marginal donor heart, xenotransplantation, artificial heart and bioartificial heart in alleviating the shortage of donor heart were investigated, and existing challenges and future directions to expand the donor pool for heart transplantation were summarized, aiming to provide reference for subsequent development of heart transplantation in clinical practice.