Standard versus bicaval techniques for orthotopic heart transplantation: an analysis of the United Network for Organ Sharing database.
OBJECTIVE
Most studies of anastomotic technique have been underpowered to detect subtle differences in survival. We analyzed the United Network for Organ Sharing database for trends in use and outcomes after either bicaval or traditional (biatrial) anastomoses for heart implantation.


METHODS
Review of United Network for Organ Sharing data identified 20,999 recipients of heart transplants from 1997 to 2007. Patients were stratified based on the technique of atrial anastomosis: standard biatrial (atrial group, n = 11,919, 59.3%), bicaval (caval group, n = 7661, 38.1%), or total orthotopic (total group, n = 519, 2.6%).


RESULTS
The use of the bicaval anastomosis is increasing, but many transplantations continue to use a biatrial anastomosis (1997, 0.2% vs 97.6%; 2007, 62.0% vs 34.7%; P < .0001). Atrial group patients required permanent pacemaker implantation more often (odds ratio, 2.6; 95% confidence interval, 2.2-3.1). Caval group patients had a significant advantage in 30-day mortality (odds ratio, 0.83; 95% confidence interval, 0.75-0.93), and Cox regression analysis confirmed the decreased long-term survival in the atrial group (hazard ratio, 1.11; 95% confidence interval, 1.04-1.19).


CONCLUSIONS
Heart transplantations performed with bicaval anastomoses require postoperative permanent pacemaker implantation at lower frequency and have a small but significant survival advantage compared with biatrial anastomoses. We recommend that except where technical considerations require a biatrial technique, bicaval anastomoses should be performed for heart transplantation.
Davies
Ryan R
RR
Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Russo
Mark J
MJ
Morgan
Jeffrey A
JA
Sorabella
Robert A
RA
Naka
Yoshifumi
Y
Chen
Jonathan M
JM
D000328:Adult; D000714:Anastomosis, Surgical; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006325:Heart Atria / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014684:Venae Cavae / Q000601:surgery*