Related Experiment Video
Updated: Jul 10, 2026
Heterotopic Cervical Heart Transplantation in Mice
Published on: August 25, 2015
Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis
Maike Schnoor1, Torsten Schäfer, Dagmar Lühmann
1Institute of Social Medicine, Medical University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. Maike.schnoor@uk-sh.de
Insights
The bicaval technique in heart transplantation shows superiority over the biatrial method, reducing early atrial pressure and perioperative mortality. This meta-analysis highlights benefits for sinus rhythm and tricuspid valve regurgitation.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Medical Technology Assessment
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Two primary surgical techniques, bicaval and biatrial, are employed.
- Comparative efficacy data between these techniques require synthesis.
Purpose of the Study:
- To systematically evaluate and compare the efficacy of the bicaval versus the biatrial technique in orthotopic heart transplantation.
- To synthesize evidence from existing studies through meta-analysis.
Main Methods:
- A systematic review and meta-analysis of published literature.
- Searches of EMBASE and Medline databases (1966-August 2006), supplemented by hand searching and reference list reviews.
- Inclusion of observational, randomized, prospective, and retrospective controlled trials comparing bicaval and biatrial techniques.
Main Results:
- Analysis of 18 prospective and 23 retrospective studies.
- Bicaval technique demonstrated significant superiority in prospective trials for lower early atrial pressure.
- Bicaval technique showed reduced perioperative mortality, less tricuspid valve regurgitation, and improved sinus rhythm.
- Retrospective analyses also supported the bicaval technique's benefits.
Conclusions:
- The bicaval technique offers clinically relevant benefits compared to the standard biatrial technique in orthotopic heart transplantation.
- Further research is needed to evaluate the longer-term benefits of the bicaval technique.
- Evidence supports the bicaval technique for improved early postoperative outcomes.
Objective:
We aimed to evaluate and compare the efficacy of the bicaval and the biatrial standard techniques in orthotopic heart transplantation.
Methods:
A systematic review with meta-analysis was performed. As data sources, we used the electronic databases EMBASE and Medline (1966-August 2006), hand searching in 4 journals, expert consultation, and reference lists of reviews. Observational and randomized and prospective and retrospective controlled trials that reported outcomes on the 2 techniques of heart transplantation were considered.
Results:
A total of 23 retrospective and 18 prospective studies were included. Meta-analyses of prospective trials including between 228 and 472 patients revealed significant superiority of the bicaval technique in comparison with the biatrial procedure for early atrial pressure (weighted mean difference, -3.95; 95% confidence interval, -6.50 to -1.40), perioperative mortality (odds ratio, 0.41; 95% confidence interval, 0.17 to 0.98), tricuspid valve regurgitation (odds ratio, 0.23; 95% confidence interval, 0.15 to 0.36), and sinus rhythm (odds ratio, 7.01; 95% confidence interval, 2.57 to 19.13). The latter also showed a significant difference in the analysis of retrospective studies (odds ratio, 2.69; 95% confidence interval, 1.55 to 4.66).
Conclusion:
In summary, this systematic review and meta-analysis provides evidence of clinically relevant beneficial effects of the bicaval technique in comparison with those of the standard technique. Nevertheless, the longer-term beneficial effects of the bicaval technique remain to be evaluated.
