Heart Perfusion for Tailored Preservation and Regeneration: Innovative Techniques in the Surgical Treatment of Advanced Heart Failure

End-stage heart failure occurs in 1-10% of cases of heart failure. There are two treatment options: mechanical support and heart transplantation. Both treatments have advantages and disadvantages. Heart transplantation is the gold standard but is limited by the availability of suitable donor hearts. This dissertation describes the potential added value of donor hearts after circulatory death in the Netherlands. In addition, restarting the central circulation in the donor (thoraco-abdominal normothermic regional perfusion) may have advantages over removing the heart directly and supplying it with blood and oxygen on a machine. The ethical dilemmas surrounding this technique are highlighted. Given the scarcity, making optimal use of available donor hearts is of great importance. To gain a better understanding of the development of primary graft failure after transplantation, the risk factors for primary graft failure have been investigated. Despite the expected increase in available donor hearts due to the use of donor hearts after circulatory death, it is expected that alternative treatment methods will be necessary to treat a larger group of patients with end-stage heart failure. The "Cardiovascular moonshot" aims to regenerate the heart outside the human body. As part of the "Cardiovascular moonshot", this thesis describes the establishment of a model to use machine perfusion of the heart for the application of alternative treatment methods.