Impact of Modified Anastomosis Sequence on Warm Ischemic Time and Clinical Outcomes in Orthotopic Heart Transplantation

Warm ischemic time (WIT) during orthotopic heart transplantation contributes to ischemiareperfusion injury, yet the influence of anastomosis sequence on WIT has received little attention.We evaluated a modified sequence in which the aortic cross-clamp is released immediately after completing the left atrial and aortic anastomoses, allowing the remaining anastomoses to be performed on a beating heart.This approach consistently shortened WIT and reduced postoperative myocardial injury biomarkers.An anastomosis sequence specifically designed to reduce WIT may provide a reproducible and clinically meaningful approach to reducing ischemia-reperfusion injury across diverse transplant settings.