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Surgical techniques for cardiac transplantation

A Trento1, L S Czer, C Blanche

  • 1Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Seminars in Thoracic and Cardiovascular Surgery
|April 1, 1996
PubMed
Summary

The biatrial cardiac transplantation technique causes persistent arrhythmias and conduction issues. A newer bicaval technique may avoid these complications, offering improved outcomes for heart transplant recipients.

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Area of Science:

  • Cardiovascular Surgery
  • Transplantation Medicine
  • Cardiac Electrophysiology

Background:

  • The established biatrial technique for cardiac transplantation, introduced over 30 years ago, has been widely used but is associated with frequent atrial arrhythmias and conduction disturbances.
  • Despite modifications, these complications persist, necessitating interventions like pacemaker insertion in a significant number of patients.

Purpose of the Study:

  • To compare the long-term outcomes of the traditional biatrial cardiac transplantation technique with a newer surgical approach.
  • To evaluate the efficacy of the bicaval technique in mitigating complications associated with cardiac transplantation.

Main Methods:

  • Review of recently published surgical series comparing the biatrial and bicaval techniques for cardiac transplantation.

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  • Analysis of patient data focusing on atrial arrhythmias, conduction abnormalities, and other postoperative complications.

    • Main Results:

    • The biatrial technique, despite modifications, continues to be linked to persistent atrial arrhythmias and atrioventricular conduction disturbances.
    • The newer bicaval technique, involving total recipient heart excision and individual anastomosis, appears to circumvent the issues observed with the biatrial method.
    • Echocardiographic follow-up in biatrial recipients revealed tricuspid/mitral regurgitation, atrial enlargement with thrombus, asynchronous atrial contraction, and early right ventricular dysfunction.

    Conclusions:

    • The biatrial cardiac transplantation technique is associated with a high incidence of postoperative arrhythmias and conduction problems.
    • The bicaval technique represents a promising alternative, potentially reducing the complications seen with the conventional biatrial approach.
    • Further research and comparative studies are warranted to fully establish the benefits of the bicaval technique in cardiac transplantation.