Orthotopic cardiac transplantation technique: A survey of current practice

Background. The Lower and Shumway technique has been the gold standard for orthotopic heart transplantation (OHT) for the past 35 years. In the last d ecade the bicaval and total techniques have been introduced but it is uncle ar how these alternative techniques have influenced the current surgical pr actice of OHT. Methods. A worldwide survey of 210 International Society of Heart and Lung Transplantation centers was conducted by questionnaire: 169 replies were re ceived; a response rate of 80%. Results. Seventy-four centers (44%) use a combination of more than one tech nique with the remaining centers (n = 95 centers) employing one technique e xclusively. The bicaval technique is the most frequently used technique in the majority of transplant procedures in 92 (54%) centers. In only 38 cente rs (22%), the standard technique was the most frequently employed technique . The total technique was the choice in 8 centers (5%). The maximum accepta ble ischemic time varied from 3 to 9 hours with a median of 5.7 hours. Only 92 centers (54%) do not use cardioplegia during implantation. Conclusions. Since its introduction, the bicaval technique has become the m ost commonly used procedure for OHT. The long-term advantage of right atria l preservation with the bicaval technique will require further studies. (C) 1999 by The Society of Thoracic Surgeons.