Moderate controlled hypothermia vs. standard ice-cold storage of cardiac allografts to expand the donor pool: insights from the GUARDIAN registry

For most of the last almost 60 years of heart transplantation, static ice storage has been the dominant means of organ preservation. This method has allowed about 4 hours of relatively safe cold ischemic time, after which the risk of graft dysfunction increases exponentially. This limitation governed our allocation system and limited our ability to explore remote and extended criteria donors. Static-controlled hypothermia was recently introduced into clinical practice, and accumulating data demonstrate superior results with preservation when compared to ice storage. This has allowed centers to increasingly consider remote and extended criteria donors. Herein, we review the available data within the Global Utilization and Registry Database for Improved Heart Preservation (GUARDIAN-Heart Registry), supporting the expanding use of controlled, static preservation.