Related Experiment Video
Updated: Dec 29, 2025
A Preclinical Model of Orthotopic Heart Transplantation in Bama Miniature Pigs Using Biatrial Technique
Published on: June 13, 2025
Biatrial Versus Bicaval Orthotopic Heart Transplantation: A Systematic Review and Meta-Analysis
Casper F Zijderhand1, Kevin M Veen1, Kadir Caliskan2
1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Insights
Bicaval orthotopic heart transplantation (OHT) shows better early and late outcomes compared to biatrial OHT. This meta-analysis suggests bicaval OHT is a preferable technique for heart transplantation patients.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Statistics
Background:
- Orthotopic heart transplantation (OHT) is a critical intervention for end-stage heart disease.
- A debate exists regarding the comparative efficacy of bicaval versus biatrial OHT techniques.
- This study addresses early and late outcomes for both OHT methods.
Purpose of the Study:
- To compare early and late outcomes of bicaval OHT versus biatrial OHT.
- To provide a meta-analysis of existing literature on OHT techniques.
- To inform surgical choices for improved patient results.
Main Methods:
- A systematic literature search was conducted up to December 2017.
- Meta-analysis of 36 studies involving 3555 biatrial and 3208 bicaval OHT cases.
- Pooled analysis of early outcomes (odds ratios) and late outcomes (rate ratios), including survival curves.
Main Results:
- Bicaval OHT demonstrated significantly better early outcomes regarding mortality, tricuspid regurgitation, mitral regurgitation, and pacemaker implantation.
- Long-term survival was superior in the bicaval OHT group (HR, 1.32; P = .008).
- Late tricuspid regurgitation was less frequent after bicaval OHT (RR, 2.14; P = .014).
Conclusions:
- Bicaval OHT offers more favorable early and late outcomes than biatrial OHT.
- The findings support bicaval OHT as a preferred surgical technique.
- This supports improved patient prognosis and reduced complications post-transplantation.
Background:
Orthotopic heart transplantation (OHT) is the gold standard treatment in end-stage heart disease. Controversy remains whether bicaval OHT is superior to biatrial OHT in both early and late outcomes. This study aimed to provide an overview of the early and late outcomes in patients who underwent a bicaval or biatrial OHT.
Methods:
A systematic literature search was performed for articles published before December 2017. Studies comparing adult patients undergoing biatrial OHT and bicaval OHT were included. Early outcomes were pooled in odds ratios and late outcomes were pooled in rate ratios. Late survival was visualized by a pooled Kaplan-Meier curve.
Results:
A total of 36 publications were included in the meta-analysis, counting 3555 patients undergoing biatrial OHT and 3208 patients undergoing bicaval OHT. Early outcomes in mortality, tricuspid regurgitation, mitral regurgitation, and permanent pacemaker implantation differed significantly in favor of the bicaval OHT patients. Long-term survival was significantly better in patients undergoing bicaval vs biatrial OHT (hazard ratio, 1.32; 95% confidence interval, 1.1-1.6; P = .008). Also, late tricuspid regurgitation was less frequently seen in the bicaval OHT patients (rate ratio, 2.14; 95% CI, 1.17-3.94; P = .014).
Conclusions:
This systematic review with meta-analysis shows that bicaval OHT results in more favorable early and late outcomes for patients undergoing a bicaval OHT compared with a biatrial OHT. Therefore, bicaval OHT should be considered as preferable technique for OHT.
