title: Hemodynamic and echocardiographic evaluation of orthotopic heart transplantation with the modified bicaval anastomosis technique.
abstract: BACKGROUND
  The purpose of this study was to evaluate the hemodynamic and echocardiographic function of hearts transplanted with the modified bicaval anastomosis technique (mBCAT).
  
  
  RESULTS
  Twenty consecutive patients (14 males, 6 females, age range 14-61 [41.3 +/-11.5 years]) were evaluated 3.4 +/-2.2 years after heart transplantation using the mBCAT. All patients were in status I on the waiting list, and 18 (90%) had had a left ventricular assist device. The donor age was 39 +/-12 years. Triple immunosuppressive regimen and cardiac biopsy were routinely performed. There was no hospital mortality. One death occurred 4.2 years after the operation because of bone marrow dysplasia and infection. The 8-year survival was 89% (95% confidence interval: 0.43-0.98). All the hemodynamic variables returned to the normal range. Low right atrial pressure (3.2 +/-1.5 mmHg) and low pulmonary wedge pressure (6.7 +/-2.1 mmHg) were associated with an excellent cardiac index (3.9 +/-0.7 L . min(-1) . m(-2)). Echocardiography revealed an excellent late peak velocity (52 +/-19 cm/s) and an E/A ratio (1.4 +/-0.6) of tricuspid flow. The grade (0-4) of tricuspid regurgitation averaged 1.5 +/-0.8.
  
  
  CONCLUSIONS
  Hemodynamic and echocardiographic results for mBCAT were excellent. The 8-year survival was 89% with all surviving patients in New York Heart Association class I. The mBCAT is easy to perform and further facilitates cardiac transplantation.
authors.affiliation: Department of Organ Transplantation, Cardiovascular Surgery, National Cardiovascular Center, Suita, Japan. skitamur@hsp.ncvc.go.jp
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kato
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Funatsu
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Akiko
authors.initials: A
authors.lastname: Kada
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000502:physiology*; D006325:Heart Atria / Q000601:surgery; D006339:Heart Rate / Q000502:physiology*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery; D014683:Vena Cava, Superior / Q000601:surgery; D055815:Young Adult