BICAVAL VERSUS ATRIAL ANASTOMOSES IN CARDIAC TRANSPLANTATION - RIGHT ATRIAL DIMENSION AND TRICUSPID-VALVE FUNCTION AT REST AND DURING EXERCISE UP TO 36 MONTHS AFTER TRANSPLANTATION

Conventional cardiac transplantation with atrial anastomoses alters at rial integrity, geometry, and possibly function. Theoretically, this m ay also contribute to the development of tricuspid insufficiency that is frequently observed after the operation. Thus more anatomic transpl antation techniques using bicaval anastomoses were recently introduced into clinical practice. Knowledge of their efficacy, however, is scar ce. Therefore right atrial size and tricuspid valve function were comp ared in patients with bicaval (group A) and standard atrial (group B) anastomoses in a randomized, prospective study. The results of this ec hocardiographic study at rest and exercise in 18 patients (bicaval n = 8; atrial 10) on the average 28 months after transplantation are pres ented. The right atrial dimension was comparable between group A patie nts and control subjects and larger in group B patients (p < 0.05). Th e incidence of tricuspid regurgitation was not different between the t wo groups at rest, but it was at exercise (50 watts of workload) (p < 0.05). This study suggests that up to 36 months after cardiac transpla ntation the technique of bicaval in contrast to atrial anastomoses pre serves right atrial size and reduces tricuspid regurgitation during ex ercise. Whether this leads to improved hemodynamics and increased exer cise capacity remains to be evaluated in a larger series of patients.