title: Short crossclamp heart transplantation: a modified technique.
abstract: Prolongation of the ischemic time in heart transplantation adversely affects the performance of the donor heart. We compared the impact of ischemic time in 30 patients who had the conventional bicaval method with declamping just after the last anastomosis (group A) and 28 who had a modified short crossclamp technique with declamping after left atrial stump, aorta, and inferior vena caval anastomosis (group B). In the operating room, 4 (13.3%) group A patients need one inotropic and 26 (86.6%) need 2 or more; one (3.3%) needed intraaortic balloon pumping. In group B, one inotropic was used in 7 (25%) patients, 4 (14.2%) need 2 or more, and 17 (60.7%) needed no inotropic. Mean crossclamp time was 80.5 ± 4.7 min in group A and 62.4 ± 5.8 min in group B. Weaning from bypass was faster in group B. Transesophageal echocardiography at the end of the operation showed more complete de-airing in group B. There were no significant differences in intensive care unit stay or the incidence of postoperative neurologic complications between the 2 groups. Easier separation from bypass, even without a hot shot, and better echocardiographic systolic parameters postoperatively are the advantages of this modified technique.
authors.affiliation: Department of Cardiovascular Surgery, Imam Medical Complex, Tehran University of Medical Sciences, Tehran, Iran. abakhshandeh@ymail.com
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Bakhshandeh
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Salehi
authors.forename: Hasan
authors.initials: H
authors.lastname: Radmehr
authors.forename: Aso Ibrahim
authors.initials: AI
authors.lastname: Ezzat
authors.forename: Gholam Ali
authors.initials: GA
authors.lastname: Riahi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*