This is the first time in Southern Italy.
The first transplant using the “Heart-in-a-Box” technology was successfully performed at ISMETT, marking a milestone as the first operation of this kind in Southern Italy. This technology, developed in the United States, has so far been used in the top transplant centers in Europe and North America.
“The heart,” explains Dr. Sergio Sciacca, head of the Heart Transplant Program at ISMETT, “arrived at our center inside a sort of sterile box inside which it was perfused with the donor’s blood and continued to beat. This technology reduces the heart’s ischemic distress because during transport the heart muscle continues to receive blood and oxygen for its metabolic functions. Additionally, biochemistry tests can be performed and data acquired to ensure a good heart function once it is transplanted.
The procurement was carried out by an ISMETT team of cardiac surgeons (Sergio Sciacca and Matteo Greco), perfusionists (Andrea Giunta and Rosi Longo), and an OR nurse (Giancarlo Cappello). The graft was connected to the device and perfused during the 6-hour journey to ISMETT continuing to beat until it reached the operating room. Here it was transplanted into a Sicilian patient who had been on the waiting list for two years.
“I express my gratitude to the institutions and for the invaluable support of the Sicilian Regional Transplant Center (CRT) that made this achievement possible,” says Dr. Michele Pilato, Director of the Cardiac Surgery and Heart Transplant Department at ISMETT. “Thanks to an exceptional team that includes the regional intensive care units coordinated by CRT we witnessed a remarkable increase in the number of heart transplants in 2024. This places ISMETT and Sicily among the leaders in Italy for number of patients treated. This cutting-edge technology will enable us to expand our offer, assessing more organs and broadening the criteria for their utilization, offering more options to our patient population with end-stage heart failure awaiting a life-saving heart transplant.”
Normally, the procured heart is stopped with a cold cardioplegic solution and transported non-beating, in thermal bags, at a temperature of 4°C, to the location where it will be transplanted. With this technique, the maximum preservation time of the heart, also called ischemia time, is about 4 hours, after which there is a high risk of inadequate recovery of the graft’s contractile function due to excessive ischemia suffered during transport. The “Heart-in-a-Box” technology almost totally eliminates ischemia time, enabling the heart to travel long distances from distant locations.
Drastically reducing ischemia times is not, however, the only advantage offered by this technology. Cardiac surgeons can monitor all the heart’s parameters, assessing its state of health in real-time, modifying hemodynamic and metabolic parameters to improve its functions, and have more time to decide whether to proceed with the transplant if the organ is at high risk of dysfunction.
“The recipient,” adds Dr. Sciacca, “was a complex patient because he was also a carrier of LVAD (the so-called artificial heart), so the intraoperative preparation was particularly delicate and complex. The patient is now doing well, still hospitalized at ISMETT, but experiencing an excellent recovery of the cardiac function and a regular postoperative course.”
