Evaluation of early postoperative results after bicaval versus standard cardiac transplantation and review of the literature

Objective Previous studies have been inconsistent in defining a clinical be nefit to the bicaval cardiac transplantation technique relative to the stan dard technique, and many major centers have not adopted this newer approach . The purpose of this study was to determine whether clinically significant benefits support utilization of the bicaval technique. Methods Sixty-eight consecutive adult patients undergoing a standard cardia c transplant were compared with 75 consecutive patients who underwent the b icaval technique during the period from 1991 to 1999. Etiology; recipient s ex, recipient age, donor age, and pulmonary vascular resistance were simila r between the two groups. Results Cardiac index ai 24 hours after operation was increased for the bic aval group relative to the standard group (3.15 +/- 0.7 vs 2.7 +/- 0.5 L/mi n/m(2), P<.05). Inotropic requirements were significantly less, and there w as significantly less tricuspid regurgitation in the bicaval group relative to the standard group. In addition, the bicaval group more frequently had a nonpaced normal sinus rhythm at 24 hours after operation (73.9% vs 50.7% [standard group], P=.025) and had Fewer postoperative arrhythmias (29.3% vs 47.7% [standard group], P<.01). Finally, although mortality was similar fo r the two groups, length of postoperative hospitalization was longer For th e standard group relative to the bicaval group (12.1 +/- 11 vs 20.4 +/- 12 days, P <.001): Review of the literature identified reduced tricuspid regur gitation and improved rhythm as consistent benefits of the bicaval techniqu e. Conclusion This review demonstrates a clinical benefit during the early pos toperative period with bicaval cardiac transplantation (relative to standar d) and encourages further utilization of this technique.