Bicaval and standard techniques in orthotopic heart transplantation: Medium-term experience in cardiac performance and survival

Objective: The aim of this study was to compare the medium-term results of right heart pressures, tricuspid valve dysfunction, overall cardiac perform ance, and survival between the bicaval and standard techniques. Method: Bet ween 1991 and 1997, 201 heart transplantations were performed in our center . Right heart catheterization was performed up to 12 months after transplan tation. Echocardiography was used to assess left ventricular and tricuspid valve function. Result: The standard technique was used in 105 cases, and t he bicaval technique was used in 96 cases. There was no difference in the a ge, preoperative parameters, pulmonary hemodynamics, or ischemic time betwe en the 2 groups. Right atrial pressure (4.3 +/- 4.0 mm Hg for the bicaval v s 10.9 +/- 4.8 mm Hg for standard technique) and mean pulmonary artery pres sure (17.5 +/- 5.3 mm Hg and 22.5 +/- 5.2 mm Hg, respectively) were lower f or the bicaval recipients up to 12 months after the operation (P = .001 and .01, respectively), Left ventricular ejection fraction was higher for the recipients of the bicaval technique up to the most recent measurement (P = .005). The prevalence of moderate or severe tricuspid regurgitation was hig her in the recipients of the standard technique up to the most recent measu rement (28% vs 7%; P = .02), The actuarial survival at 1, 3, and 5 years wa s 74%, 70%, and 62% for the recipients of the standard technique versus 87% , 82%, and 81% for the recipients of the bicaval technique (P < .03, < .04, and < .02, respectively). Conclusion: The bicaval technique maintains good left ventricular function, lower incidence and severity of tricuspid valve dysfunction, and improved survival compared with the standard technique.