title: Comparison of standard and bicaval approach in orthotopic heart transplantation: 10-year follow-up.
abstract: BACKGROUND
  The present study compared 86 patients who underwent orthotopic heart transplantation by bicaval and standard techniques.
  
  
  METHODS
  Patients already followed in the first year after heart transplantation were studied at 10 years of follow-up, this time evaluating the prevalence of arrhythmias, conduction disturbances and mitral or tricuspid regurgitation.
  
  
  RESULTS
  The following arrhythmias were observed: atrial fibrillation (one patient from the standard group), ventricular premature beats and ventricular fibrillation (each in one patient from the bicaval group). Conduction disturbances were found in 25 patients in the standard group (48.1%) and in 19 patients in the bicaval group (55.9%, P = 0.515). Twenty patients had a mono- or bifascicular block in the standard group (38.5%) versus 19 patients in the bicaval group (55.9%); furthermore, five patients in the standard group (9.6%) and none in the bicaval group had a permanent pacemaker (Fisher's exact test: P = 0.074). Mitral regurgitation was present in 13 (26.5%) and five (16.1%) patients, respectively, in the standard and bicaval groups (Fisher's exact test: P = 0.411): it was grade 1 in 12 and five patients and grade 2 in one and zero patients, respectively. Tricuspidal regurgitation was observed in 26 (53.1%) and 13 (41.9%) patients, respectively, in the standard and bicaval groups (Fisher's exact test: P = 0.366): it was grade 1 in 23 and 13 patients and grade 2 in three and zero patients, respectively. Cumulative survival was 75% at 10 years from transplant in this relatively old population of patients (mean age = 58 years).
  
  
  CONCLUSIONS
  In conclusion, our data do not support any definite mandate for either of the surgical techniques.
authors.affiliation: Divisione Cardiochirurgia, Istituto di Chirurgia Generale e dei Trapianti d'Organo, Fondazione IRCCS Policlinico S. Matteo, Università degli Studi di Pavia, Pavia, Italy. amgrande@libero.it
authors.forename: Antonino M
authors.initials: AM
authors.lastname: Grande
authors.forename: Roberto
authors.initials: R
authors.lastname: Gaeta
authors.forename: Carlo
authors.initials: C
authors.lastname: Campana
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Laura
authors.initials: L
authors.lastname: Riva
authors.forename: Andrea M
authors.initials: AM
authors.lastname: D'Armini
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology