A COMPARATIVE-STUDY OF STANDARD AND TOTAL ORTHOTOPIC CARDIAC TRANSPLANTATION

The classical orthotopic heart transplant modifies size and geometry o f the atria, may affect mitral and tricuspid function, and ventricular filling. A technical modification with subtotal excision of the recip ient's heart, with anastomosis of a cuff of left atrium and of venae c avae has been used and compared with 2 consecutive series of transplan tations : 70 classical (group I) 1986-1991, and 50 modified (group II) 1992-1994. The patients were similar for age, pretransplant character istics, postoperative treatment. The aortic cross-clamping in the reci pient (duration of cardiac excision and graft implantation) has been l onger in group II (87 +/- 19 mm vs 63 +/- 15 ; p < 0.001). No surgical complication due to the technique was observed. Mortality was similar in the 2 groups (14 % group I, 18 % group II; NS). Five patients of g roup I has a systemic embolism (1 month to 5 years after transplant), none in group II. Two comparable groups of 30 patients were studied at least 6 months after transplantation with : surface EKG, Holter, tran sthoracic and esophageal echodoppler. A larger number of EKG anomalies , a significant increase in the size of atria, a significantly larger number of mitral and tricuspid insufficiencies, an increase in the var iability of E/A ratio (left ventricular filing parameter) were noted a fter classical transplantation. Spontaneous contrast echo and thrombus in the left atrium were also noted after classical transplant. We con clude that these technical modifications result in a geometry and anat omy closer to normal. Less anomalies of the cardiac function were foun d, Due to the absence of left atrial thrombus and of systemic embolims we think that there is a definite advantage in this technically rathe r simple approach.