*Purpose: The standard technology for heart preservation for transplantation is cold static storange on ice. No temperature control is performed routinley and therefore lower or higher temperatures can occur leading to injury of the graft. The Paragonix SherpaPak Cardiac Transportation System (CTS) (Paragonix Technologies, MA, USA) has been approved in Europe and the USA for clinical use. This single-use disposable device is designed for cold preservation of donor hearts. We report our first clinical experience with the SherpaPak.

*Methods: Since November 2018 SherpaPak has been used in 8 non consecutive cases in our insitutition. Decision to use the device was done in procurements with either high risk donors, long ischemic times or both. Donor risk was calculated with both the Eurotransplant donor heart risk score and the donor heart risk index (both JHLT 2012). Recipient risk was calculated via the IMPACT score (Ann Thor Surg 2011).

*Results: Median recipient age was 59 years. All patients were male and 38% had previous sternotomies. Median impact score was 10 (19% expected 1 year mortality). All donors were male with a median age of 40 years. Median LVEF was 55%. Median norepinephrine support was 0,18mcg/kg/min, with 2 donors on multiple catecholamine support. Median ET donor risk score was 18.5 (40% risk of non-acceptance) and median Donor risk score was 7 (18% expected 1-year mortality). Median ischemic time was 290 minutes. Donor hearts were preserved at a median of 5,5C temperature. 5 Patients were successfully weaned from bypass at the first attempt with low inotropic support. 3 Patients developed primary graft dysfunction ISHLT Grade 2 and were weaned from bypass via ECMO. All hearts recovered within 72 hours and ECMO could be explanted. All patients could be extubated within 7 days post transplant. 2 patients died of sepsis at 4 and 12 weeks after transplant. All the patients are alive with normal graft function at a median time of 9,5 months follow-up

*Conclusions: The Paragonix SherpaPak provides consistend temperature during transportation of grafts and could be successfully used with long ischemic times and high risk donor hearts.

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