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Right ventricular function in orthotopic total atrioventricular heart transplantation
H B Bittner1, E P Chen, S W Kendall
1Department of General and Cardiothoracic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Summary
Total heart transplantation preserves sinus rhythm and right ventricular function better than the standard technique. This innovative approach offers a feasible alternative for cardiac surgery, maintaining critical cardiac performance post-transplant.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Cardiac Physiology
Background:
- Introduced total orthotopic heart transplantation technique, including bicaval and pulmonary vein anastomoses.
- Compared conventional ventricular transplantation with atrioplasty to the total technique.
- Focused on right ventricular performance differences between the two heart transplant methods.
Purpose of the Study:
- To evaluate the efficacy of total orthotopic heart transplantation.
- To compare right ventricular performance between total and conventional heart transplantation.
- To assess the impact on sinus rhythm and atrial function.
Main Methods:
- Conducted 12 total and 12 standard orthotopic heart transplantations in mongrel dogs.
- Utilized micromanometry, sonomicrometry, and ultrasonic flow probes to analyze right ventricular function.
- Employed Fourier analysis to determine right ventricular power and pulmonary vascular impedance.
Main Results:
- No significant differences in cardiac ischemic and bypass times between groups.
- Sinus rhythm preserved in all total transplantations versus one standard transplantation.
- Right ventricular recruitable stroke work conserved in the total group, but decreased 39% in the standard group.
Conclusions:
- Total atrioventricular transplantation is a feasible alternative technique.
- The total technique conserves normal sinus rhythm and right ventricular diastolic function.
- No significant differences in ischemic or bypass times were observed.