title: Clinical experience with one hundred consecutive patients undergoing orthotopic heart transplantation with bicaval and pulmonary venous anastomoses.
abstract: OBJECTIVE
  Our objective was to assess survival, need for pacemaker insertion, and rejection frequency with a new surgical technique of orthotopic heart transplantation using bicaval and pulmonary venous anastomoses.
  
  
  METHODS
  We retrospectively reviewed 100 consecutive patients who had orthotopic heart transplantation with this technique between July 1991 and September 1995.
  
  
  RESULTS
  The mean age was 57.0 +/- 11.1 years, with 51 patients being 60 years or older. The mean donor/recipient weight ratio was 0.92, and in 28 patients the ratio was less than 0.8. The early (30-day) survival was 100% and the 1- and 2-year survivals were 98% +/- 2% and 96% +/- 2%, respectively. Survival was not affected by age or by the duration of the OKT3 therapy (p > 0.2 for each of these parameters). The seven late deaths were due to infection (n = 2), graft atherosclerosis (n = 3), acute rejection (n = 1), and nonspecific graft failure (n = 1). No permanent pacemaker was required in the first 6 months after the operation, and all the patients were discharged in normal sinus rhythm. Freedom from treated rejection was significantly greater in patients with 7 days of OKT3 therapy than in patients with 14 days of therapy (p < 0.0001).
  
  
  CONCLUSIONS
  Orthotopic heart transplantation with bicaval and pulmonary venous anastomoses offers an improved alternative to the standard biatrial technique, with a 30-day mortality of 0,% in 100 consecutive patients, excellent intermediate-term survival, and elimination of the need for pacemaker insertion. More normal anatomic configuration and synchronous function of the atria may have contributed to these results.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif. 90048, USA.
authors.forename: A
authors.initials: A
authors.lastname: Trento
authors.forename: J M
authors.initials: JM
authors.lastname: Takkenberg
authors.forename: L S
authors.initials: LS
authors.lastname: Czer
authors.forename: C
authors.initials: C
authors.lastname: Blanche
authors.forename: S
authors.initials: S
authors.lastname: Nessim
authors.forename: M H
authors.initials: MH
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: Kass
authors.forename: S
authors.initials: S
authors.lastname: Raissi
authors.forename: J M
authors.initials: JM
authors.lastname: Matloff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015150:Echocardiography, Doppler; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery; D014684:Venae Cavae / Q000601:surgery*