Right ventricle-sparing heart transplant: Promising new technique for recipients with pulmonary hypertension

Background. Right heart failure remains the leading early cause of mortalit y after heart transplantation, especially with antecedent pulmonary hyperte nsion. Paradoxically, the discarded recipient right heart, acclimated to pu lmonary hypertension, is often stronger than its nonconditioned donor repla cement. Heterotopic ("piggy-back") transplantation is plagued by problems r elated to the retained, dilated, hypocontractile left ventricle (lung compr ession, systemic emboli, arrhythmias). Were it possible to retain the recip ient's right heart, excising only the left ventricle, this could have impor tant advantages, especially in severe pulmonary hypertension. This report d escribes such a technique. Methods and Results. In four transplantation experiments (dogs), right vent ricular-sparing transplantation proved technically feasible and hemodynamic ally successful. Bleeding after excision of the left ventricle was easily c ontrolled. Back-bleeding from the native aortic valve (now open into the pe ricardial space) was not problematic. All atrial, aortic, and pulmonary art erial connections proved feasible. The preserved recipient right heart of a ll animals remained in stable sinus rhythm. All recipients were easily wean ed from cardiopulmonary bypass, maintaining mean arterial pressures 60 to 1 10 mm Hg. Conclusions. This investigation develops a technique for donor right ventri cle sparing in cardiac transplantation, demonstrating technical and hemodyn amic feasibility. This method holds promise for the unsolved clinical probl em of right heart failure after orthotopic heart transplantation with antec edent pulmonary hypertension. (C) 2000 by The Society of Thoracic Surgeons.