Bicaval vs biatrial anastomosis techniques in orthotopic heart transplantation: An updated analysis of the UNOS database

Maning, Jennifer; Blumer, Vanessa; Hernandez, Gabriel A.; Acuna, Edgar; Li, Hua; Chaparro, Sandra

doi:10.1111/jocs.14887

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…28,29 Other effects Some authors reported a shorter duration of hospital stay in relation to the surgical technique. 30 In our experience, the hospital stay before HTx in the group 2 was slightly higher be-cause of increasing waiting times on the list in the past decade. After heart transplantation, the length of hospital-stay did not differ between the groups.…”

Section: Arrhythmiamentioning

confidence: 61%

Impact of the operative technique on mid‐ and long‐term results following paediatric heart transplantation

Rosenthal,

Grinninger,

Pozza

et al. 2024

ESC Heart Failure

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AimsThe aim of this study is to evaluate and compare the impact of the bicaval technique versus the biatrial technique (by Lower and Shumway) in paediatric heart transplant patients. Only a few studies investigate this matter regarding the long‐term outcome after paediatric heart transplantation. We compared the two surgical methods regarding survival, the necessity of pacemaker implantation.Methods and resultsAll 134 patients (aged <18 years) – (group‐1) biatrial (n = 84), versus (group‐2) bicaval (n = 50), who underwent heart transplantation between October 1988 and December 2021, were analysed. Freedom from events were estimated using the Kaplan–Meier method. Potential differences were analysed using the log rank test and Cox proportional hazard models. Mean ± standard deviation: Bypass time (per minutes) was higher in the group 1 as compared with group 2 (P = 0.050). Survival was not significantly different (P = 0.604) in either groups. Eighteen patients required permanent pacemaker implantation in the group 1 and only one patient required it in the group 2 (P = 0.001).ConclusionsPaediatric heart transplantation using bicaval technique results similar long‐term survival compared with the biatrial technique. The incidence of atrial rhythm disorders was significantly higher in the biatrial group, requiring a higher frequency of pacemaker implantation in this group. As a results, the bicaval technique has replaced the biatrial technique in our centre.

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Section: Arrhythmiamentioning

confidence: 61%

Impact of the operative technique on mid‐ and long‐term results following paediatric heart transplantation

Rosenthal,

Grinninger,

Pozza

et al. 2024

ESC Heart Failure

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“…Studies have shown that bicaval anastomosis is less likely to require a pacemaker, and patients need less time in the hospital [62].…”

Section: Heterotopic Htxmentioning

confidence: 99%

Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

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“…Subsequently, bicaval anastomosis and other modified methods were introduced to reduce the above complications. However, postoperative complications such as donor heart distortion, atrial thrombosis, and anastomotic hemorrhage still exist (12), which is why we propose the novel modified bicaval anastomosis technique of HTx. Riberi and his colleagues found, through transesophageal echocardiography, that the surface of the left atrium was expanded to 33±4 cm in the classical transplantation anastomosis method (13).…”

Section: Four-corners Traction Prevents Donor Heart Distortionmentioning

confidence: 99%

Effect of novel bicaval anastomosis technique for transplantation with and without prior cardiac surgery history

Shi¹,

Ren²,

Zhang³

et al. 2021

Ann Transl Med

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Background: To evaluate the graft outcomes after orthotopic heart transplantation (HTx) with a novel bicaval anastomosis technique between recipients with and without a history of prior cardiac surgery.Methods: Of 70 patients who underwent HTx with a novel four-corners traction bicaval anastomosis technique from August 2017 to November 2019, 60 recipients underwent the HTx procedure as their first cardiac surgery (group A), while 10 recipients underwent HTx after prior cardiac surgery (group B).Patients in the two groups were compared in terms of their preoperative baseline variables such as etiological categories, history of blood transfusion and panel reactive antibody (PRA), intraoperative operation time and blood infusion volume, postoperative treatment time, and complications such as acute rejection and 30-day mortality as well as survival rates.Results: Preoperative variables were comparable in group A and group B except for the history of blood transfusion (0% vs. 90.0%, P<0.001, respectively); the level of PRA was 7.5%±5.8% and 9.5%±10.9% for group A and B, respectively (P=0.583), but the time of the operation was nearly 1 hour longer for group B than group A (all P<0.05). No cases of left atrial thrombosis and donor heart distortion were observed in either group. Reoperation (1.7% vs. 10.0%, P=0.267), infection (0% vs. 10.0%, P=0.142), other postoperative complications as well as the 30-day mortality (1.7% vs. 10.0%, P=0.267), and postoperative survival rates (91.5% vs. 90.0%, P=0.805) were comparable between the two groups (all P>0.05).Conclusions: Four-corner traction bicaval anastomosis combined with a continuous everting suture technique may result in approximately comparable prognoses for heart recipients with a history of cardiac surgery when compared with those without a history of cardiac surgery and this technique may reduce the incidence of left atrial thrombosis and distortion. Further follow-up of the long-term outcomes will be required to validate these results.

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Bicaval vs biatrial anastomosis techniques in orthotopic heart transplantation: An updated analysis of the UNOS database

Cited by 4 publications

References 25 publications

Impact of the operative technique on mid‐ and long‐term results following paediatric heart transplantation

Impact of the operative technique on mid‐ and long‐term results following paediatric heart transplantation

Heart Transplantation

Effect of novel bicaval anastomosis technique for transplantation with and without prior cardiac surgery history

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