Related Experiment Video
Updated: Mar 31, 2026
Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
Atrial function in heart transplant recipients operated with the bicaval technique
Odd Bech-Hanssen1,2, Valeria Pergola1, Mohammed Al-Admawi1
1a Heart Centre, King Faisal Specialist Hospital & Research Centre , Riyadh , Kingdom of Saudi Arabia.
Insights
Heart transplant recipients show significantly reduced atrial reservoir function. This dysfunction is linked to elevated pulmonary capillary wedge pressure and impaired right ventricular function in heart transplant (HTx) patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiac Imaging
Background:
- Heart transplantation (HTx) using the bicaval technique results in a right atrium (RA) composed entirely of donor tissue and a left atrium (LA) with both donor and recipient components.
- Assessing atrial function post-HTx is crucial for understanding cardiac performance and patient outcomes.
Purpose of the Study:
- To evaluate and compare atrial function in heart transplant recipients versus healthy controls.
- To identify key factors contributing to atrial dysfunction in HTx patients.
Main Methods:
- Retrospective study including 43 HTx recipients and 30 healthy controls.
- Echocardiography was performed within 24 hours of right heart catheterization (RHC) in HTx patients.
- Peak longitudinal atrial systolic strain (ɛ) was used to assess atrial reservoir function.
Main Results:
- Left atrial (LA) and right atrial (RA) reservoir function were significantly reduced in HTx recipients compared to controls (LA-ɛ: 18% vs. 44%; RA-ɛ: 22% vs. 69%, p < 0.001).
- Moderate inverse relationships were observed between atrial strain and ventricular filling pressures.
- Multiple regression analysis identified pulmonary capillary wedge pressure (PCWP) and LA minimum volume index as determinants of LA function, and right ventricular strain for RA function.
Conclusions:
- Atrial reservoir function is markedly diminished in heart transplant recipients.
- Elevated PCWP and LA enlargement contribute to reduced LA reservoir function.
- Impaired longitudinal right ventricular function is associated with reduced RA reservoir function in HTx patients.
Objectives:
In heart transplantation (HTx) with the bicaval technique the whole right atrium (RA) is donor tissue while the left atrium (LA) consists of both donor and recipient tissue. The aims of the study were to describe atrial function in comparison with healthy controls and to identify determinants of dysfunction.
Design:
Forty-three patients and 30 controls were retrospectively included. Echocardiography was performed within 24 h of right heart catheterization (RHC) (HTx recipients).
Results:
The peak longitudinal atrial systolic strain (ɛ) described the atrial reservoir function. The LA and RA reservoir function were reduced versus controls (LA-ɛ 18 ± 8 versus 44 ± 10%; RA-ɛ 22 ± 10 versus 69 ± 17%, p < 0.001). There were moderate relationships between atrial-ɛ and ventricular filling pressure (r = -0.64 for LA-ɛ; r = -0.57 for RA-ɛ). In a multiple regression analysis the LA-ɛ was determined by pulmonary capillary wedge pressure (PCWP) and LA minimum volume index (r = -0.71) while RA-ɛ was dependent on the right ventricular ɛ (r = -0.77).
Conclusions:
Atrial reservoir function is markedly reduced in HTx recipients related to elevated PCWP and LA-enlargement in the LA and in the RA impaired longitudinal right ventricular function.
