Non‐intubated general anesthesia with a supraglottic airway for heart transplantation: a preliminary cohort study of feasibility and enhanced recovery

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.