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Orthotopic heart transplantation with bicaval and pulmonary venous anastomoses
C Blanche1, M Valenza, L S Czer
1Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Insights
This modified heart transplant technique reduces tricuspid regurgitation and eliminates the need for early pacemakers. The approach may offer improved long-term hemodynamic results for heart transplant recipients.
Area of Science:
- Cardiology
- Surgical Innovation
- Transplantation Medicine
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- The standard surgical technique can be associated with complications such as tricuspid regurgitation and bradyarrhythmia.
- Optimizing surgical approaches is crucial for improving patient outcomes post-transplantation.
Purpose of the Study:
- To evaluate an alternative technique for orthotopic heart transplantation involving total recipient atria excision.
- To compare the outcomes of this modified technique with the standard transplantation method.
- To assess the impact of the modified technique on postoperative complications and long-term hemodynamic results.
Main Methods:
- A modified orthotopic heart transplantation technique was employed, featuring total recipient atria excision and bicaval and pulmonary venous anastomoses.
- Forty consecutive patients underwent transplantation using the modified technique.
- A control group of 64 patients who received standard orthotopic heart transplantation was retrospectively compared.
Main Results:
- The modified technique significantly reduced the incidence of postoperative tricuspid regurgitation (p = 0.003).
- Early pacemaker implantation for severe bradyarrhythmia was completely eliminated in the modified technique group (p = 0.003).
- A trend towards reduced postoperative mitral regurgitation was observed with the modified technique, though not statistically significant.
Conclusions:
- The modified orthotopic heart transplantation technique demonstrates significant advantages in reducing tricuspid regurgitation and early bradyarrhythmia.
- This approach offers potential anatomic and physiologic benefits that may lead to improved long-term hemodynamic performance.
- The modified technique represents a promising advancement in heart transplantation surgery.
Abstract:
We present our experience with an alternative technique for orthotopic heart transplantation. It consists of total excision of the recipient's atria, with the donor's heart implantation performed using bicaval end-to-end anastomoses as well as pulmonary venous anastomoses. Forty consecutive patients receiving transplants in this fashion were compared with 64 patients who underwent orthotopic transplantation with the standard technique. The incidence of postoperative tricuspid regurgitation was reduced in patients receiving transplants with the new surgical approach (p = 0.003). In addition, the need for pacemaker implantation for severe bradyarrhythmia in the early (0 to 6 weeks) posttransplantation period (p = 0.003) was eliminated. Although not statistically significant, there was a trend in the reduction of postoperative mitral regurgitation in patients who received transplants by the modified technique. Based on this experience, we believe this modified technique for orthotopic heart transplantation has an anatomic and physiologic advantage that may improve long-term hemodynamic results.