Orthotopic heart transplantation: Standard versus bicaval technique

We compared orthotopic heart transplantation (HT) by bicaval technique with the standard technique. Between January 1995 and December 1997, 117 patien ts underwent 118 HTs; 71 patients (15 women and 56 men) had 72 HTs by stand ard technique and 46 patients (9 women, 37 men) underwent HT using bicaval procedures. Preoperative parameters were similar in both groups; 5 patients who underwent the standard technique and no patients who underwent bicaval procedures required permanent pacemakers (p = NS). Isoproterenol infusion was significantly longer in the standard technique. Major perioperative arr hythmias (ventricular tachycardia and fibrillation, asystole) appeared in 8 .2% and 7.0% of standard and bicaval HTs, respectively; atrial fibrillation appeared in 13.1% and 4.6%, respectively (p = NS). At 1 month, mitral and tricuspid regurgitation rates were higher in the standard group (p = NS); a t 1 year only tricuspid regurgitation was still higher (p = NS). Right atri al pressure, Wood units, cardiac output, and cardiac index were examined (p = NS). At multivariate analysis, interaction between preoperative Wood uni ts and transplant type was elicited for Wood units at 1 month and for right atrial pressure at 1, 3, and 6 months. In the high resistance subgroup, th e patients who underwent bicaval procedures had higher resistances at 1 mon th. In the low resistance subgroup, right atrial pressure was higher in pat ients who underwent standard techniques at 1, 3, and 6 months follow-up. Th us, bicaval HT was found to be safe, without surgically related complicatio ns, it provoked significantly less blood loss, and required less isoprotere nol use. No significant advantages were observed in conduction disturbances and major arrhythmias or regarding the need for temporary or permanent pac emakers. (C) 2000 by Excerpta Medica, Inc.