Modified operation technique for orthotopic heart transplantation

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Abstract
Atrioventricular (AV) valve dysfunction with tricuspid regurgitation isa common finding after orthotopic heart transplantation (HTx). In 20patients the heart transplantation was performed with bicaval anastomosesand the results were compared to the precedent 20 patients operated withthe standard technique. The right atrium of the recipient was completelyremoved and the caval anastomoses were performed on the beating heartduring reperfusion. Using an interrupted suture line, no stenoses at thevenous anastomoses were seen as known from the early implantation techniquein heart-lung transplantation. Due to a more stable sinus rhythm only 15%of the patients in the bicaval group needed prolonged pacing (≫ 30 min)versus 55% (P ≪ 0.01) in the group with standard operation. One to 3months after surgery the transthoracic echocardiographic evaluation of theAV valve function showed tricuspid valve regurgitation (TVR) in 20% of thepatients with bicaval anastomoses versus 75% with a right atrialanastomosis (P ≪ 0.001). Tricuspid valve regurgitation during the first2 weeks (in 31% of recipients with bicaval and in 70% with atrialanastomoses) improved in all recipients with bicaval anastomoses and in 14%of the recipients with atrial anastomosis. The modification of theoperation technique did not result in significantly longer bypass time (75+/- 14 versus 68 +/- 14 min) and ischemia time (44 +/- 12 versus 41 +/- 9min with local organ procurement and 111 +/- 24 versus 101 +/- 19 min withdistant organ procurement). The AV valve function and the postoperativerhythm after orthotopic HTx can be improved by implanting the heart withbicaval anastomoses.

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