RESTING HEMODYNAMICS AFTER TOTAL VERSUS STANDARD ORTHOTOPIC HEART-TRANSPLANTATION

Total orthotopic heart transplantation (TOHT) requires longer surgery than standard orthotopic heart transplantation (SOHT), but offers norm al anatomy and synchronous atrial contraction. We endeavored to test w hether TOHT improves resting hemodynamics. We analyzed 60 patients wit h SOHT and 66 with TOHT transplanted between 12/89 and 7/94. Age, preo perative NYHA class, ejection fraction, and donor characteristics were similar. After applying exclusion criteria at 2 weeks postoperatively , 53 SOHT and 58 TOHT patients were accepted for further study. Right- heart hemodynamics were examined at 2 weeks and 6 months posttransplan t. Despite a longer ischemic time (161 +/- 36 vs. 142 +/- 37 min, p = 0.004), cardiac output and index were higher in the TOHT group at 2 we eks (6.1 +/- 1.4 vs. 5.4 +/- 1.0 L/min, TOHT vs. SOHT, p = 0.01; and 3 .3 +/- 0.7 vs. 2.9 +/- 0.6 L/min/m(2), p = 0.005) but similar at 6 mon ths (5.9 +/- 1.2 vs. 5.6 +/- 1.4 L/min; and 3.0 +/- 0.6 vs. 2.9 +/- 0. 7 L/min/m(2)). Right-atrial pressure was lower with TOHT at both time points (7 +/- 4 vs. 9 +/- 4 mmHg, p = 0.02; and 5 +/- 2 vs. 7 +/- 3, p = 0.0006). Wedge pressure was similar at 2 weeks (12 +/- 5 vs. 13 +/- 5) but lower in the TOHT group at 6 months (11 +/- 5 vs. 13 +/- 5, p = 0.045). Heart rate (bpm) was higher at both time points with TOHT (8 4 +/- 10 vs. 75 +/- 12, p = 0.0003; and 90 +/- 12 vs. 82 +/- 9, p = 0. 0006). Pulmonary vascular resistance was similar at both time points. Despite a longer ischemic time, total orthotopic heart transplantation does not impair postoperative cardiac function. There is an early imp rovement in cardiac output, a sustained higher heart rate reflecting p reservation of donor sinus node function, and a lower right-atrial pre ssure.