TNF and endothelial dysfunction: This results in release of a multitude of cytokines (i.e., IL-1b, IL-6, IL-8, Il-10, TNF-alpha, etc.)and is a key contributor to functional decline during ESHP, presumably due to exacerbated oxidative stress, endothelial dysfunction, and inflammasome formation, resulting in increased myocardial tissue stress.6, 7 Therefore, interventions to limit inflammation may be beneficial.4, 6, 7 One pragmatic approach is to add an immunosuppressant to the perfusate during ESHP, such as methylprednisolone.