Beating Heart Transplantation May Facilitate Liberal Use of Extended Criteria Donors

Objective Extended criteria donor (ECD) hearts are particularly vulnerable to ischemia-reperfusion injury and thus more prone to primary graft dysfunction. We test the hypothesis that by minimizing ischemia-reperfusion and cooling-rewarming injury, ex-vivo machine perfusion and beating heart transplant (BHT) can allow liberal and safer use of ECD hearts.Methods Between 2023 and 2025, 130 BHTs (109, isolated, 21 combined with kidney and/or liver) were performed in our center. These were retrospectively compared to 138 historical and concurrent transplants performed using controlled cold storage (CCS) between 2020 and 2025. ECD was defined based on the EXPAND trial criteria.Results Among the BHT group, 64% (83/130) utilized ECD hearts, compared to 37% (51/138) in the CCS group (PConclusion Beating heart implantation using continuous normothermic perfusion may allow expanded use of ECD hearts, including from older and distant donors, without compromising early outcomes.