title: Exercise performance comparison of bicaval and biatrial orthotopic heart transplant recipients.
abstract: BACKGROUND
  The standard biatrial technique for orthotopic heart transplantation uses a large atrial anastomosis to connect the donor and recipient atria. A modified technique involves bicaval and pulmonary venous anastomoses and is believed to preserve the anatomic configuration and physiological function of the atria. Bicaval heart transplantation reduces postoperative valvular regurgitation and is associated with a lower incidence of pacemaker insertion.
  
  
  OBJECTIVE
  The aim of this study was to compare postoperative functional capacity and exercise performance in patients with bicaval and biatrial orthotopic heart transplantation.
  
  
  METHODS
  Patients were selected for the study if they did not have any of the following: obstructive coronary artery disease (>50% stenosis), severe mitral or tricuspid regurgitation, signs of rejection (grade≥1B-1R) on endomyocardial biopsy during the prior year, respiratory impairment, a permanent pacemaker, orthopedic or muscular impediments, or lived more than 150 miles from the medical center. A total of 27 patients qualified. In 15 patients who received a biatrial heart transplant and 12 patients with a bicaval heart transplant, a stationary bicycle exercise test was performed. Ventilatory gas exchange and maximum oxygen consumption measurements were measured.
  
  
  RESULTS
  Recipient and donor characteristics, including body surface area, donor/recipient weight mismatch, immunosuppressive regimen, and self-reported weekly exercise activity, did not differ between the biatrial and bicaval groups (P=not significant [NS]). At peak exercise, similar heart rate, workload, oxygen consumption, carbon dioxide production, ventilation, functional capacity, and exercise duration were found between the 2 groups (P=NS). Patients in the biatrial group were studied later than patients in the bicaval group (6.54±0.71 vs 4.68±0.28 years; P<.001).
  
  
  CONCLUSIONS
  There were no significant differences in the exercise capacity between patients with biatrial versus bicaval techniques for orthotopic heart transplantation. Factors other than the atrial connection (such as cardiac denervation, immunosuppressive drug effect, or physical deconditioning) may be more important determinants of subnormal exercise capacity after heart transplantation. Nevertheless, the reduction in morbidity and postoperative complications and the simplicity in the bicaval technique suggest that bicaval heart transplantation offers advantages when compared with the standard biatrial technique.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. lawrence.czer@cshs.org
authors.forename: L S C
authors.initials: LS
authors.lastname: Czer
authors.forename: M H
authors.initials: MH
authors.lastname: Cohen
authors.forename: S P
authors.initials: SP
authors.lastname: Gallagher
authors.forename: L A
authors.initials: LA
authors.lastname: Czer
authors.forename: H J
authors.initials: HJ
authors.lastname: Soukiasian
authors.forename: M
authors.initials: M
authors.lastname: Rafiei
authors.forename: J R
authors.initials: JR
authors.lastname: Pixton
authors.forename: M
authors.initials: M
authors.lastname: Awad
authors.forename: A
authors.initials: A
authors.lastname: Trento
mesh_terms: D000368:Aged; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011659:Pulmonary Gas Exchange; D012123:Pulmonary Ventilation; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome