Modified operation technique for orthotopic heart transplantation

Area of Science:

• Cardiology
• Surgical Innovation
• Transplantation Medicine

Background:

• Atrioventricular (AV) valve dysfunction, specifically tricuspid regurgitation, is a frequent complication post-orthotopic heart transplantation (HTx).
• Traditional HTx techniques involving atrial anastomosis are associated with higher rates of AV valve issues and arrhythmias.

Purpose of the Study:

• To evaluate the efficacy of the bicaval anastomoses technique in improving AV valve function and postoperative rhythm after HTx.
• To compare outcomes of bicaval anastomoses with the standard technique in heart transplantation.

Main Methods:

• A comparative study involving 40 patients undergoing orthotopic heart transplantation.
• 20 patients received the bicaval anastomoses technique (recipient right atrium removed, caval anastomoses on beating heart).
• 20 patients received the standard technique with right atrial anastomosis; outcomes were compared.

Main Results:

• Bicaval anastomoses group showed significantly lower tricuspid valve regurgitation (TVR) at 1-3 months (20% vs. 75%, P < 0.001) compared to the standard group.
• Prolonged pacing (>30 min) was needed in only 15% of bicaval patients versus 55% in the standard group (P < 0.01).
• Early TVR improved in all bicaval patients, whereas only 14% improved in the standard group.

Conclusions:

• The bicaval anastomoses technique improves atrioventricular valve function and postoperative sinus rhythm after orthotopic heart transplantation.
• This modified surgical approach offers a superior alternative to the standard technique for heart transplantation, reducing complications like tricuspid regurgitation.