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Updated: Jun 11, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
[Should biatrial heart transplantation still be performed?: A Meta-analysis]
Rafael Fagionato Locali1, Priscila Katsumi Matsuoka, Tiago Cherbo
1Universidade Federal de São Paulo, SP, Brasil. rafael.locali@hotmail.com
Insights
Total and bicaval heart transplantation techniques demonstrate superior outcomes compared to the biatrial method. These advanced techniques reduce complications and improve hemodynamic function, making them preferable for orthotopic heart transplantation.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Medical Technology Assessment
Background:
- The biatrial technique, while historically considered the gold standard, has potential drawbacks in heart transplantation.
- Emerging total and bicaval techniques aim to improve patient outcomes post-transplantation.
Purpose of the Study:
- To systematically evaluate and compare the clinical outcomes of total and bicaval heart transplantation techniques against the traditional biatrial technique.
- To determine if total and bicaval techniques offer significant advantages over the biatrial approach.
Main Methods:
- A comprehensive systematic review and meta-analysis of relevant medical literature.
- Inclusion of randomized, prospective, and retrospective controlled studies identified across major scientific databases.
- Assessment of intraoperative and postoperative parameters, including clinical and hemodynamic variables.
Main Results:
- Total and bicaval techniques showed significantly lower rates of atrial arrhythmias, tricuspid valve regurgitation, mortality, and embolic events.
- Reduced bleeding volume, lower requirements for temporary and permanent pacemakers, and shorter intensive care unit stays were observed.
- Improved hemodynamic profiles, including lower pulmonary capillary pressure, mean pulmonary artery pressure, and right atrial pressure, were noted.
Conclusions:
- Total and bicaval orthotopic heart transplantation techniques are prognostically superior to the biatrial technique.
- The biatrial technique should be reserved for exceptional cases, with total and bicaval techniques becoming the preferred standard of care.
Abstract:
The outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed, Lilacs, Web of Science, Scirus, Scopus, Google Scholar, and Scielo databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were identified and 36 were included in our review. The number of atrial arrhythmias, tricuspid valve regurgitation, deaths, and embolic events, as well as bleeding volume; temporary and permanent pacemaker requirement; and length of stay in the intensive care unit are significantly lower for the total and bicaval techniques than for the biatrial technique. Also, hemodynamic variables such as pulmonary capillary pressure, mean pulmonary artery pressure, and right atrial pressure are lower in total and bicaval transplantation. In prognostic terms, total and bicaval orthotopic heart transplantations are better, than the biatrial transplantation. Therefore, indication of the biatrial technique for transplantation should be the exception, not the rule.
