A prospective randomized trial of complete atrioventricular transplantation versus ventricular transplantation with atrioplasty.
BACKGROUND
The standard technique of ventricular transplantation with atrioplasty (SOHT) distorts atrial anatomy. This may compromise diastolic ventricular function, impair atrioventricular valve competence and elevate resting ANP secretion. In contrast, complete atrioventricular anastomosis (CAVT) preserves atrial geometry.


METHODS
We evaluated long term outcome in a prospective randomized trial of CAVT vs. SOHT. The primary outcome measures were peak oxygen uptake, atrioventricular valve regurgitation and ANP secretion.


RESULTS
58 recipients (median age 49 years; range 21-64) were consecutively randomized (29 CAVT; 29 SOHT). There were no differences in total ischaemic time, cardiopulmonary bypass time, postoperative bleeding or immunosuppression. Cardiopulmonary exercise tolerance testing was performed by 29 recipients at 742 to 1825 days. Pulmonary function was equivalent. Peak oxygen consumption expressed as a percentage of predicted maximum was 53.5% with CAVT and 63.8% with SOHT (p = 0.14). Echocardiography was performed on 41 recipients at 944 to 1665 days. There was less tricuspid regurgitation with CAVT (3/22 [13.6%] CAVT vs. 10/19 [52.6%] SOHT; p = 0.019). The incidence of mitral regurgitation was similar (5/22 [22.7%] CAVT vs. 4/19 [21.1%] SOHT; p = 0.803). Resting ANP secretion was assessed in 17 recipients at 1013 to 1812 days. All were hemodynamically stable and none had concurrent rejection. Resting ANP secretion was less with CAVT (CAVT: 283 pg/ml; SOHT: 521.4; p = 0.041).


CONCLUSIONS
Peak oxygen consumption was not influenced by implantation technique. However, CAVT reduced the incidence of tricuspid regurgitation and attenuated the elevation in resting ANP secretion.
Bainbridge
A D
AD
Transplant Unit, Papworth Hospital NHS Trust, Papworth Everard, Cambridge, UK.
Cave
M
M
Roberts
M
M
Casula
R
R
Mist
B A
BA
Parameshwar
J
J
Wallwork
J
J
Large
S R
SR
D000328:Adult; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D001783:Blood Flow Velocity; D001794:Blood Pressure; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D018618:Echocardiography, Doppler, Color; D017079:Exercise Tolerance; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000378:metabolism / Q000637:transplantation*; D016027:Heart Transplantation / Q000379:methods* / Q000502:physiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000378:metabolism / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis; D011446:Prospective Studies
D009320:Atrial Natriuretic Factor