title: Declining need for permanent pacemaker insertion with the bicaval technique of orthotopic heart transplantation.
abstract: BACKGROUND
  The bicaval technique of orthotopic heart transplantation, in contrast to the standard biatrial technique, may better preserve right atrial anatomy and, thus, may be associated with less sinus node dysfunction and less atrioventricular valve dysfunction.
  
  
  OBJECTIVE
  To compare the requirement for permanent pacemaker insertion and the incidence of atrioventricular valve dysfunction following heart transplantation with either the standard or the bicaval technique.
  
  
  METHODS
  A retrospective analysis was conducted of a consecutive cohort of 105 patients, older than 18 years of age, undergoing heart transplantation with either the standard (n=48) or the bicaval (n=57) technique from December 1998 to December 2001.
  
  
  RESULTS
  Cross-clamp (100 min versus 112 min; P=0.012) and donor ischemic (222 min versus 276 min; P=0.005) times were significantly prolonged in the bicaval group. Perioperative morbidity and mortality were statistically similar between the groups. Bicaval transplantation resulted in a significant decrease in the requirement for permanent pacemaker insertion at 30 days (13% versus 0%; P=0.008) and 90 days (17% versus 1.8%; P=0.01) after transplantation. There was a nonsignificant trend toward a decreased degree of tricuspid valve regurgitation (mean 1.81 versus 1.36; P=0.141) and mitral valve regurgitation (mean 1.04 versus 0.79; P=0.348) with the bicaval technique.
  
  
  CONCLUSIONS
  Although associated with longer cross-clamp and donor ischemic times, the data demonstrated a significant reduction in the need for permanent pacemaker insertion at 30 and 90 days post-transplantation with the bicaval technique. There was no statistically significant difference in the degree of mitral and tricuspid valve regurgitation between the two groups.
authors.affiliation: Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta T6G 2B7.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meyer
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Modry
authors.forename: Kevin
authors.initials: K
authors.lastname: Bainey
authors.forename: Arvind
authors.initials: A
authors.lastname: Koshal
authors.forename: John C
authors.initials: JC
authors.lastname: Mullen
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.forename: Samantha
authors.initials: S
authors.lastname: Bowker
authors.forename: Shaohua
authors.initials: S
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D016027:Heart Transplantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging