Abstract
BACKGROUND: Endotracheal intubation (EI) with mechanical ventilation has been the long-standing standard of care for general anesthesia of heart transplantation. The aim of this study is to evaluate the feasibility and recovery impact of a non‑intubated anesthesia (NIA) strategy using a supraglottic airway. METHODS: This study involved a single-center retrospective cohort (February 2023-August 2025). Recipients who were managed with NIA were compared with those receiving conventional EI. Primary outcomes were time to oral intake and time to first mobilization; secondary outcomes included estimated blood loss, intraoperative variables, vasoactive requirements, and intensive care unit length of stay. RESULTS: Seventeen recipients were included in the analysis (NIA, n=8; EI, n=9). NIA was associated with earlier oral intake [3.8 (3.5-5.0) vs. 27 (22-65) h; P=0.001], earlier mobilization [1.5 (1.3-2.0) vs. 4.0 (4.0-7.0) days; P=0.001], and lower estimated blood loss [375 (300-450) vs. 800 (500-1,000) mL; P=0.02]. Cardiopulmonary bypass, cross‑clamp, operation, and cold ischemia times trended shorter with NIA, but the differences were not statistically significant. No statistically significant differences were observed in intraoperative vasoactive-inotropic score or intraoperative vasoactive-inotropic dose. One planned NIA case converted to EI. CONCLUSIONS: In selected recipients, non‑intubated general anesthesia heart transplantation with a supraglottic airway is feasible and associated with accelerated recovery. Prospective evaluations are warranted.