A prospective randomized trial of complete atrioventricular transplantation versus ventricular transplantation with atrioplasty

Background: The standard technique of ventricular transplantation with atri oplasty (SOHT) distorts atrial anatomy. This may compromise diastolic ventr icular function, impair atrioventricular valve competence and elevate resti ng ANP secretion. In contrast, complete atrioventricular anastomosis (CAVT) preserves atrial geometry. Methods: We evaluated long term outcome in a prospective randomized trial o f CAVT vs. SOHT. The primary outcome measures were peak oxygen uptake, atri oventricular valve regurgitation and ANP secretion. Results: 58 recipients (median age 49 years; range 21-64) were consecutivel y randomized (29 CAVT; 29 SOHT). There were no differences in total ischaem ic time, cardiopulmonary bypass time, postoperative bleeding or immunosuppr ession. Cardiopulmonary exercise tolerance testing was performed by 29 reci pients at 742 to 1825 days. Pulmonary function was equivalent. Peak oxygen consumption expressed as a percentage of predicted maximum was 53.5% with C AVT and 63.8% with SOHT (p = 0.14). Echocardiography was performed on 41 re cipients at 944 to 1665 days. There was less tricuspid regurgitation with C AVT (3/22 [13.6%] CAVT vs 10/19 [52.6%] SOHT; p = 0.019). The incidence of mitral regurgitation was similar (5/22 [22.7%] CAVT vs 4/19 [21.1%] SOHT; p = 0.803). Resting ANP secretion was assessed in 17 recipients at 1013 to 1 812 days. All were hemodynamically stable and none had concurrent rejection . Resting ANP secretion was less with CAVT (CAVT: 283 pg/ml; SOHT: 521.4; p = 0.041). Conclusions: Peak oxygen consumption was not influenced by implantation tec hnique. However, CAVT reduced the incidence of tricuspid regurgitation and attenuated the elevation in resting ANP secretion. J Heart Lung Transplant 1999;18:407-413.