CLINICAL-EXPERIENCE WITH 100 CONSECUTIVE PATIENTS UNDERGOING ORTHOTOPIC HEART-TRANSPLANTATION WITH BICAVAL AND PULMONARY VENOUS ANASTOMOSES

Objective: Our objective was to assess survival, need for pacemaker in sertion, and rejection frequency with a new surgical technique of orth otopic heart transplantation using bicaval and pulmonary venous anasto moses. Methods: We retrospectively reviewed 100 consecutive patients w ho had orthotopic heart transplantation with this technique between Ju ly 1991 and September 1995, Results: The mean age was 57.0 +/- 11.1 ye ars, with 51 patients being 60 years or older, The mean donor/recipien t weight ratio was 0.92, and in 28 patients the ratio was less than 0. 8, The early (30-day) survival was 100% and the 1- and 2-year survival s were 98% +/- 2% and 96% +/- 2%, respectively, Survival was not affec ted by age or by the duration of the OKT3 therapy (p > 0.2 for each of these parameters), The seven late deaths were due to infection (n = 2 ), graft atherosclerosis (n = 3), acute rejection (n = 1), and nonspec ific graft failure (n = 1), No permanent pacemaker was required in the first 6 months after the operation, and all the patients were dischar ged in normal sinus rhythm, Freedom from treated rejection was signifi cantly greater in patients with 7 days of OKT3 therapy than in patient s with 14 days of therapy (p < 0.0001), Conclusions: Orthotopic heart transplantation with bicaval and pulmonary venous anastomoses offers a n improved alternative to the standard biatrial technique, with a 30 d ay mortality of 0% in 100 consecutive patients, excellent intermediate -term survival, and elimination of the need for pacemaker insertion, M ore normal anatomic configuration and synchronous function of the atri a may have contributed to these results.