Objective:Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods: Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventricular end diameter （LVED） of the patients were 91

87

and 83 mm

and ejection fraction （EF） were 24%

20%

12.9%

respectively. Once the declaration of brain death had been made

the median sternotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation

the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty

the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava

the superior vena cava and all pulmonary veins. After donor heart was removed

it was infused with University of Wisconsin （UW） solution by gravity at a temperature of 4-6 ℃

then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4-6 ℃. The ischemic times of donor heart were 9

8 and 6 h

respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed

the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96

44 and 49 min

respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results: The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient’s condition was fine in 25

30 and 32 months after operation. The blood pressure was 130/90

140/95 and 120/80 mmHg

respectively

and LVED was 51

49 and 53 mm; EF was 50%

54% and 60%

respectively. Cardiothoracic ratio was 0.63

0.55

and 0.64

respectively. Conclusion: Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0-4 ℃ may exceed 6 h

and receive comparable middle-term outcomes.