Important Issues of Heart and Liver En Bloc Final Edition

En-bloc heart and liver procurement is a highly demanding surgical procedure that requires meticulous coordination between thoracic and abdominal teams, with several critical technical issues determining the success of the retrieval. One of the most important considerations is precise hemodynamic management before cross-clamping to preserve both myocardial and hepatic perfusion until cardioplegia and cold flush are administered. The dissection must be performed carefully to avoid injury to the suprahepatic and infrahepatic vena cava, ensuring adequate length for subsequent implantation. Similarly, preservation of the celiac trunk and superior mesenteric artery for arterial inflow to the liver, while maintaining integrity of the ascending aorta for the heart, is essential. Correct timing of aortic cross-clamp and cold perfusion with cardioplegia, followed by a balanced flush of both abdominal and thoracic organs, is critical to minimize ischemic injury. Special care must also be taken to avoid traction or torsion on the suprahepatic cava and to coordinate diaphragmatic division in a way that keeps the en-bloc specimen intact and oriented for safe back-table preparation. Proper communication between teams and attention to organ preservation solutions, cooling methods, and sequence of procurement remain the cornerstone of successful en-bloc heart–liver retrieval.