Related Experiment Video
Updated: Aug 14, 2026
A Preclinical Model of Orthotopic Heart Transplantation in Bama Miniature Pigs Using Biatrial Technique
Published on: June 13, 2025
Biatrial or bicaval technique for orthotopic heart transplantation: which is better?
Neville A G Solomon1, James McGiven, Xiao-Zhong Chen
1Department of Cardiothoracic Surgery, Green Lane Hospital, Green Lane, Auckland, New Zealand.
Insights
The bicaval technique in heart transplantation showed trends towards less pacing and tricuspid regurgitation compared to the biatrial method. However, these differences did not reach statistical significance, indicating similar overall outcomes in this study.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Surgical Techniques
Background:
- Orthotopic heart transplantation initially utilized the biatrial technique.
- The bicaval technique has recently gained popularity in heart transplantation procedures.
Purpose of the Study:
- To evaluate the advantages and outcomes of the bicaval technique compared to the traditional biatrial technique in orthotopic heart transplantation.
- To determine if the bicaval technique offers significant benefits over the biatrial approach.
Main Methods:
- A retrospective study comparing 37 patients who underwent bicaval heart transplantation with 38 patients who underwent biatrial heart transplantation between 1996 and 2001.
- Data was collected by reviewing patient charts to assess perioperative variables and outcomes.
Main Results:
- No significant differences were observed between the bicaval and biatrial groups in terms of low cardiac output, intraaortic balloon pump use, re-exploration rates, or perioperative mortality.
- The bicaval group showed a trend towards less need for temporary and permanent pacing, and lower central venous pressure at one week post-surgery, though not statistically significant.
- Fewer cases of severe tricuspid regurgitation were noted in the bicaval group during follow-up compared to the biatrial group.
Conclusions:
- While the bicaval technique demonstrated trends towards reduced pacing requirements, less tricuspid regurgitation, and lower central venous pressures, these findings did not achieve statistical significance.
- The study concluded that there were no substantial differences in overall outcomes between the bicaval and biatrial techniques for orthotopic heart transplantation based on the analyzed data.
Background:
Orthotopic heart transplantation was done by the biatrial technique initially and the bicaval technique has become popular recently.
Aims:
This study aims to determine if bicaval technique is advantageous.
Methods:
Consecutive transplants performed between 1996 and 2001 were divided into two groups-37 patients done by bicaval and 38 by biatrial technique. Data accumulation was by retrospective study of patient charts.
Results:
Both groups had similar preoperative variables. There were no differences in low cardiac output (18.9% versus 26.3%, p = 0.62), intraaortic balloon pump insertion (16.2% versus 15.7%, p = 1.0), re-exploration (13.5% versus 18.4%, p = 0.79) and perioperative mortality (5.4% versus 7.9%, p = 1.0) in the bicaval versus biatrial groups. Temporary (13.5% versus 39.4%, p = 0.15) and permanent pacing (0 versus 3 patients) tended to be less frequent and central venous pressure measured at 1-week was lower in the bicaval group (mean 13.8 +/- 6cm versus 14.9 +/- 5.4cm, p = 0.42), but not attaining statistical significance. Severe tricuspid regurgitation was seen in one bicaval versus five biatrial patients at follow-up.
Conclusions:
Though bicaval group tended to require less pacing, had less tricuspid regurgitation and had lower central venous pressures, these did not attain statistical significance. There were otherwise no obvious differences in outcome. SHORT ABSTRACT: Seventy five consecutive orthotopic heart transplantations done during the period 1996-2001 by bicaval or biatrial surgical technique were compared. There was no difference in low cardiac output, intraaortic balloon pump insertion and mortality but the bicaval patients tended to have less pacing and diuretic requirements and lower central venous pressures, though not attaining statistical significance.
