Reply

We thank Dr Luque-Rincon for the supportive comments and his important questions. 1 We are aware that our loco-regional perfusion (LRP) concept comes with some complexity, as it requires profound cardiovascular and technical expertise in organ-specific hemodynamics, extracorporeal perfusion (ie, extracorporeal membrane oxygenation), and catheter-based technologies.Clinically, we consider the LRP concept a prime example of an advanced cardiovascular hybrid approach for highprecision therapeutics delivery.As such, and as for any innovative technology, systematic implementation with a certain learning curve is required to enable broad clinical adoption.However, because gene therapies are usually performed in large tertiary or academic centers, the mandatory infrastructure and multidisciplinary experts to perform LRP procedures are mostly already available.Such hospitals will therefore play a pivotal role in the clinical implementation process and serve as "centers of excellence" to provide advice and training on LRP procedures, thereby boosting broad clinical adoption.