title: Influence of bicaval anastomoses on late occurrence of atrial arrhythmia after heart transplantation.
abstract: BACKGROUND
  The standard technique for orthotopic heart transplantation includes right and left atrial anastomoses, which potentially disturb the integrity of the donor atria. Consequently, electrophysiologic abnormalities such as atrial flutter and fibrillation may occur even late after heart transplanation.
  
  
  METHODS
  Over a 3-year period, 39 heart transplantations were performed using a standard right atrial anastomosis (group A), and 40 were done using bicaval anastomoses (group B). In each group, data of 30 consecutive patients with a minimum follow-up of 9 months were reviewed retrospectively to assess the incidence of atrial arrhythmia after hospital discharge.
  
  
  RESULTS
  Early postoperatively, there was no difference in the duration of temporary pacemaker requirement and incidence of permanent pacemaker implantation (group A, 7%; group B, 7%; not significant) between the two groups. In 12 patients in group A (40%), 16 episodes of atrial flutter and fibrillation were detected 20 to 205 days after heart transplantation. In group B, 1 patient (4%) suffered from atrial fibrillation on day 116 after the operation (p < 0.001).
  
  
  CONCLUSIONS
  Preservation of the integrity of the right donor atrium by construction of bicaval anastomoses results in a significantly decreased incidence of atrial flutter and fibrillation after heart transplantation when compared with the standard technique.
authors.affiliation: Department of Cardiovascular Surgery, Christian-Albrechts-University, Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Brandt
authors.forename: W
authors.initials: W
authors.lastname: Harringer
authors.forename: S W
authors.initials: SW
authors.lastname: Hirt
authors.forename: K P
authors.initials: KP
authors.lastname: Walluscheck
authors.forename: J
authors.initials: J
authors.lastname: Cremer
authors.forename: H H
authors.initials: HH
authors.lastname: Sievers
authors.forename: A
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000517:prevention & control; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D001282:Atrial Flutter / Q000209:etiology / Q000517:prevention & control; D005260:Female; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors