Cleveland Clinic in Florida Welcomes New Heart Transplant Surgeon

Heart transplant surgeon Antonio R. Polanco, MD, the newest member of the heart transplant team at Cleveland Clinic in Florida, is on a mission to help patients on the fringe of transplant candidacy – individuals who have been turned away from other centers and have no other hope.

“My primary aspirations are to help grow the Heart Transplant Program here in Weston, contribute to quality improvements, and increase transplantation candidacy for the sickest patients,” shares Dr. Polanco.

Based at Cleveland Clinic Weston Hospital, Dr. Polanco’s clinical focus includes heart transplantation, mechanical circulatory support devices (MCSDs), and complex adult cardiothoracic surgery. Before joining Cleveland Clinic, he played a pivotal role in revitalizing the heart transplant program at Johns Hopkins Hospital in Baltimore, Maryland.

“I’m excited to be part of the innovative team at Cleveland Clinic in Florida and to contribute my experience with advanced transplantation techniques and protocols that generated excellent patient outcomes in Baltimore,” he says.

DCD heart transplantation

Dr. Polanco credits the use of donation after circulatory death (DCD) hearts for part of the significant growth achieved at Johns Hopkins. He performed the hospital’s first DCD heart transplant in 2024, and the team went on to transplant 13 of these extended criteria organs that year.

“In just two years, our heart transplant volume more than tripled, and by the time I left Baltimore nearly 40% of our transplants were with DCD hearts,” confirms Dr. Polanco.

Last year Cleveland Clinic’s heart transplant team in Florida also performed their first cases of DCD heart transplantation, becoming the first center to do so in South Florida.

“I look forward to expanding this approach and contributing to the evaluation criteria used to assess DCD hearts offered to patients here in Weston,” states Dr. Polanco. “Part of the challenge is to overcome the perception that DCD hearts are inferior, which is certainly not the case.”

The largest study to date confirms that DCD heart transplantation has one-year survival rates similar to donation after brain death (DBD) heart transplant. Both groups had approximately 92% survival at one year, according to the report from the International Society for Heart and Lung Transplantation (ISHLT).

Going the distance

The growing use of DCD hearts nationally has been propelled by a number of organ procurement and preservation advancements, including hypothermic oxygenated perfusion, normothermic ex vivo systems, and most recently, temperature-controlled hypothermia. These techniques make it possible to safely use DCD hearts while also decreasing time and geographic constraints on matching DBD hearts.

Transplant centers typically have a transport window of about 4-6 hours for donor hearts when using static cold storage (SCS). This is the traditional preservation method that entails putting the heart in a bag with cold preservation solution and placing it on ice, which keeps it at a temperature of 0°C to 4°C.

“With static cold storage, we don’t know what temperature fluctuations are occurring nor what is going on biologically as the heart warms up,” explains Dr. Polanco. “The advantage of temperature-controlled hypothermia is that we are able to keep the heart at a safe temperature and limit the metabolic changes that can lead to primary graft dysfunction.”

One method of temperature-controlled hypothermia, called 10°C static storage, is currently being used at a handful of U.S. transplant centers, including Johns Hopkins and Cleveland Clinic in Ohio.

Early data has demonstrated improved intraoperative and postoperative outcomes with this technique despite longer cold ischemic times. In one case, a donor and recipient were separated by approximately 2,700 miles. The transplant team reported “superb early allograft function” after 10 hours of ischemia.

“At Johns Hopkins, we took a novel approach using an inexpensive commercial cooler to maintain donor hearts at 10°C ,” notes Dr. Polanco. “This expanded our transport window up to 8 hours and allowed us to retrieve hearts from as far away as Nevada and Seattle, while achieving very good patient outcomes.”

He notes there is a lot of research underway trying to determine the optimal temperature for storing donor hearts, adding “I think temperature-controlled hypothermia is the way of the future.”

Hope for high-risk patients

In addition to applying his experience using DCD hearts and innovative preservation methods to expand the donor pool available to Cleveland Clinic patients, Dr. Polanco is also eager to explore opportunities to broaden transplant candidacy for high-risk patients who have fewer options.

“I’ve been part of more than 100 heart transplants over the past two years and some of them have involved very complex patients who were turned away by other centers,” says Dr. Polanco.

Among them were patients with highly sensitized immune systems, often the result of multiple pregnancies, prior transplant, or a history of transfusions. They have low compatibility with potential donors and are at a higher risk of immediate, catastrophic organ rejection.

Dr. Polanco points to desensitization strategies that can be used to reduce the level of harmful antibodies in the blood of recipients before and after surgery: plasmapheresis, intravenous immunoglobulin (IVIG) therapy, and new targeted medications. “These techniques allowed us to extend lifesaving care to patients often deemed too high-risk for transplantation,” he says.

Combined heart-liver transplant

Another population of patients with fewer options are adults with congenital heart disease (CHD). These individuals often have long-term organ damage that may require dual-organ heart transplantation.

In particular, patients with CHD who have survived into adulthood thanks to medical and surgical interventions at a young age are driving an increase in combined heart-liver transplantation (HLT). Since the first case in 1984, more than 400 adult HLTs have been performed in the United States, including 18 cases at Cleveland Clinic in Ohio between 2006 and mid-2024.

Dr. Polanco has participated in 5 HLTs and hopes to establish a heart-liver transplant program at Weston Hospital. The Transplant Center is approved to perform adult heart, liver and kidney transplantations and has performed both kidney-heart and liver-kidney transplants.

“Unfortunately, patients with congenital heart disease are often referred when they're too sick because they are young and look so well,” observes Dr. Polanco. “So when they do come in, they have terrible hearts, livers and kidneys, and they're just too sick.”

Dr. Polanco welcomes the opportunity to be a resource for patients who have hypoplastic heart syndrome and other CHDs. “While some patients may not need a heart transplant yet, there are opportunities to support medical therapy and slow heart failure progression.”