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Does the surgical technique used in the orthotopic heart transplant affect the results regarding the rhythm?
Ibrahim Kara1, Yasin Ay, Mehmet Yanartaş
1Cardiovascular Surgery Center, Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital, İstanbul. ikara7881@hotmail.com
Insights
The bicaval technique for heart transplantation results in fewer rhythm problems and less need for pacemakers compared to the biatrial technique. This study found the bicaval method superior for early recovery and reduced complications.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Surgical techniques, including the bicaval and biatrial methods, aim to restore cardiac function and improve patient outcomes.
- Early postoperative rhythm disturbances and pacemaker requirements are significant indicators of surgical success and patient morbidity.
Purpose of the Study:
- To compare the incidence of temporary and permanent pacemaker insertion following heart transplantation.
- To evaluate early postoperative rhythm problems associated with the bicaval versus biatrial surgical techniques.
- To identify risk factors influencing pacemaker requirement after orthotopic heart transplantation.
Main Methods:
- A retrospective analysis of 61 patients undergoing orthotopic heart transplantation between 1989 and 2008.
- Patients were categorized into two groups: biatrial (n=28) and bicaval anastomosis (n=33).
- Statistical analyses included Chi-square, Fischer's exact, Mann-Whitney U tests, and logistic regression to identify predictors of pacemaker insertion.
Main Results:
- The biatrial group showed significantly higher rates of temporary pacemaker requirement, left bundle branch block (LBBB), and atrioventricular block (AV block).
- The bicaval group experienced significantly less tricuspid and mitral insufficiency postoperatively.
- Hypertension, donor age, and the biatrial technique were identified as risk factors for temporary pacemaker use.
Conclusions:
- The bicaval surgical technique is associated with a lower incidence of rhythm disturbances and pacemaker needs compared to the biatrial technique.
- Factors predicting temporary pacemaker insertion include hypertension, donor age, and the use of the biatrial technique.
- The bicaval technique demonstrated superior outcomes regarding early postoperative morbidity and rhythm management in heart transplantation.
Objective:
The aim of this study was to compare the requirement for temporary and permanent pacemaker insertion and the incidence of the problems regarding the rhythm following heart transplantation with the bicaval or biatrial technique in the early postoperative period.
Methods:
Sixty-one patients underwent orthotopic heart transplantation between the dates of September 1989 and December 2008 in our clinics were included to the study. The study was designed as retrospective analysis, and all data were collected from hospital records. The transplantation was performed by using standard biatrial method in 28 of the patients, by using bicaval anastomosis method in 33 of the patients. Statistical analyses were performed using Chi-square, Fischer's exact and Mann-Whitney U tests. Predictors of temporary and permanent pacemaker insertion were analyzed using logistic regression analysis.
Results:
In the biatrial group, the temporary pacemaker requirement (p<0.05), left bundle branch block (LBBB) (p<0.01) and atrioventricular block (AV block) (p<0.05) were observed statistically significantly more than in bicaval anastomosis group. In addition, in the biatrial group, one patient needed implantation of permanent pacemaker and one patient-implantable cardioverter defibrillator. On the postoperative echocardiographic evaluation, in the patients operated with the bicaval technique, the tricuspid (p<0.01) and mitral insufficiency (p<0.01) were observed significantly less. In the logistic regression analysis, hypertension (OR: 1.053, 95% CI: 1.019-1.176, p<0.05), donor age (OR: 1.016, 95% CI: 1.023-1.038, p<0.05) and application of the operation with the biatrial technique (OR: 10.287, 95% CI: 1.298-91.278, p<0.01) were determined as the risk factors requiring the temporary pacemaker usage. In the bicaval group, arrhythmia (ventricular and atrial premature beats) and atrioventricular valve insufficiency were observed less, the rhythm returned to normal in an earlier period.
Conclusion:
Biatrial surgical technique, donor age and hypertension were determined as significant predictors of temporary pacemaker insertion in the orthotopic heart transplantation. Atrioventricular block, left bundle branch block, and arrhythmia frequency was significantly less in the bicaval group. In terms of factors affecting morbidity, the bicaval technical results were found superior than biatrial technique.
