Abstract： Objective To investigate the clinical results of the perioperative extracorporeal membrane oxygenation(ECMO)technique instead of conservative CPB used in the heart transplantation operation with long ischemic time donor hearts.Methods In 2006 the ECMO technique instead of conservative CPB was tried in the heart transplantation in 4 cases of long ischemic time donor hearts with ischemic time arranging from 4.8 to 8.0 h.During the operation the pump blood flow rate was controlled at 4.5-5.0 L/min. The conservative ECMO canula connection was retained after the assisted blood flow was reduced to one half after the operation.Then the patients returned back to ICU with the ECMO assistance and the ECMO was removed in the following suitable time.Results Totally 4 cases of heart transplantation were performed with the ECMO techniques instead of the CPB.All the hearts rebeated automatically after the successful operation.The mean cross clamp time was(90±3)min with on pump(136±14)min.The femoral artery blood flow rate during the ECMO machines were removed the next day.All the recipients recovered without right ventricular failure or obvious tricuspid regurgitation which were commonly seen after heart transplantation Postoperative bleeding occurred in 2 cases and lymphoid leakage and leg nerve overreact phenomenon in 1 case respectively.All the 4 cases discharged with NYHA Ⅰ/Ⅱcardiac function without tricuspid regurgitation.The mean left ventricle end-diastolic dimension was 37-43 mm and the left ventricle ejection fraction arranged from 56% to 64 %.Conclusion Replacing the routine CPB with ECMO techniques in the heart transplantation could effectively protect the donor hearts even with long cold ischemic time and improve the cardiac function recovery.