Optimizing outcomes in heart transplantation: multidisciplinary Heart Teams and mechanical circulatory support for primary graft dysfunction

Assad Haneya; Pia Lanmüller; Bernd Panholzer; Wiebke Sommer; Wiktor Kuliczkowski; Mateusz Sokolski; Roman Przybylski; Bastian Schmack; Sadeq Ali-Hasan-Al-Saegh; Sho Takemoto; Rachad Zayat; Nikos Werner

doi:10.1093/eurheartjsupp/suaf003

Optimizing outcomes in heart transplantation: multidisciplinary Heart Teams and mechanical circulatory support for primary graft dysfunction

Eur Heart J Suppl. 2025 Apr 28;27(Suppl 4):iv55-iv61. doi: 10.1093/eurheartjsupp/suaf003. eCollection 2025 Apr.

Authors

Affiliations

¹ Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, Nordallee 1, Trier 54292, Germany.
² Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany.
³ Charité-Universitätsmedizin Berlin, Department of Cardiothoracic and Vascular Surgery, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
⁴ Department for Cardiac Surgery, UKSH Campus Kiel, Arnold-Heller-Straße 3, Haus C, Kiel 24105, Germany.
⁵ Institute for Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland.
⁶ Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
⁷ Cardiochirurgy and Transplantology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland.
⁸ Department of Cardiothoracic Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover 30625, Germany.
⁹ Center for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, 13th Street, Building 149, Charlestown, MA 02129, USA.
¹⁰ Heart Centre Trier, Barmherzigen Brueder Hospital, Internal Medicine III/Cardiology, Nordallee 1, Trier 54292, Germany.

Abstract

Heart transplantation (HTx) is a definitive treatment for selected patients with advanced heart failure. However, primary graft dysfunction (PGD), a severe early complication, is a major cause of post-HTx morbidity and mortality. This paper explores the pathophysiology, diagnostic approaches, and management strategies for PGD, with a particular focus on temporary mechanical circulatory support (MCS) devices such as venoarterial extracorporeal membrane oxygenation and Impella. It also highlights the essential role of the multidisciplinary Heart Team in optimizing outcomes through patient-tailored MCS selection and timely intervention.

Keywords: Advanced heart failure; Heart Team; Heart transplantation; Mechanical circulatory support; Multidisciplinary care; Primary graft dysfunction.