Biatrial or bicaval technique for orthotopic heart transplantation: which is better?
BACKGROUND
Orthotopic heart transplantation was done by the biatrial technique initially and the bicaval technique has become popular recently.


OBJECTIVE
This study aims to determine if bicaval technique is advantageous.


METHODS
Consecutive transplants performed between 1996 and 2001 were divided into two groups-37 patients done by bicaval and 38 by biatrial technique. Data accumulation was by retrospective study of patient charts.


RESULTS
Both groups had similar preoperative variables. There were no differences in low cardiac output (18.9% versus 26.3%, p = 0.62), intraaortic balloon pump insertion (16.2% versus 15.7%, p = 1.0), re-exploration (13.5% versus 18.4%, p = 0.79) and perioperative mortality (5.4% versus 7.9%, p = 1.0) in the bicaval versus biatrial groups. Temporary (13.5% versus 39.4%, p = 0.15) and permanent pacing (0 versus 3 patients) tended to be less frequent and central venous pressure measured at 1-week was lower in the bicaval group (mean 13.8 +/- 6cm versus 14.9 +/- 5.4cm, p = 0.42), but not attaining statistical significance. Severe tricuspid regurgitation was seen in one bicaval versus five biatrial patients at follow-up.


CONCLUSIONS
Though bicaval group tended to require less pacing, had less tricuspid regurgitation and had lower central venous pressures, these did not attain statistical significance. There were otherwise no obvious differences in outcome. SHORT ABSTRACT: Seventy five consecutive orthotopic heart transplantations done during the period 1996-2001 by bicaval or biatrial surgical technique were compared. There was no difference in low cardiac output, intraaortic balloon pump insertion and mortality but the bicaval patients tended to have less pacing and diuretic requirements and lower central venous pressures, though not attaining statistical significance.
Solomon
Neville A G
NA
Department of Cardiothoracic Surgery, Green Lane Hospital, Green Lane, Auckland, New Zealand.
McGiven
James
J
Chen
Xiao-Zhong
XZ
Alison
Peter M
PM
Graham
Kenneth J
KJ
Gibbs
Helen
H