Does the surgical technique used in the orthotopic heart transplant affect the results regarding the rhythm

Abstract

Objective: The aim of this study was to compare the requirement for temporary and permanent pacemaker insertion and the incidence of the problems regarding the rhythm following heart transplantation with the bicaval or biatrial technique in the early postoperative period. Methods: Sixty-one patients underwent orthotopic heart transplantation between the dates of September 1989 and December 2008 in our clinics were included to the study. The study was designed as retrospective analysis, and all data were collected from hospital records. The transplantation was performed by using standard biatrial method in 28 of the patients, by using bicaval anastomosis method in 33 of the patients. Statistical analyses were performed using Chi-square, Fischer's exact and Mann-Whitney U tests. Predictors of temporary and permanent pacemaker insertion were analyzed using logistic regression analysis. Results: In the biatrial group, the temporary pacemaker requirement (p<0.05), left bundle branch block (LBBB) (p<0.01) and atrioventricular block (AV block) (p<0.05) were observed statistically significantly more than in bicaval anastomosis group. In addition, in the biatrial group, one patient needed implantation of permanent pacemaker and one patient-implantable cardioverter defibrillator. On the postoperative echocardiographic evaluation, in the patients operated with the bicaval technique, the tricuspid (p<0.01) and mitral insufficiency (p<0.01) were observed significantly less. In the logistic regression analysis, hypertension (OR: 1.053, 95% CI: 1.019-1.176, p<0.05), donor age (OR: 1.016, 95% CI: 1.023-1.038, p<0.05) and application of the operation with the biatrial technique (OR: 10.287, 95% CI: 1.298-91.278, p<0.01) were determined as the risk factors requiring the temporary pacemaker usage. In the bicaval group, arrhythmia (ventricular and atrial premature beats) and atrioventricular valve insufficiency were observed less, the rhythm returned to normal in an earlier period. Conclusion: Biatrial surgical technique, donor age and hypertension were determined as significant predictors of temporary pacemaker insertion in the orthotopic heart transplantation. Atrioventricular block, left bundle branch block, and arrhythmia frequency was significantly less in the bicaval group. In terms of factors affecting morbidity, the bicaval technical results were found superior than biatrial technique. (Anadolu Kardiyol Derg 2012; 12: 255-60) Key words: Cardiac transplantation, surgery, artificial pacemaker, arrhythmia, logistic regression analysis 255 ÖZET Amaç: Bu çalışmanın amacı, bikaval ya da biatrial teknik ile kalp naklini takiben kalıcı ve geçici kalp pili gereksinimi ve ritim ile ilgili problemlerin sıklığını karşılaştırmaktır. Yöntemler: Kliniğimizde Eylül 1989 ile Aralık 2008 yılları arasında ortotopik kalp nakli yapılan 61 hasta çalışmaya dahil edildi. Bu çalışma retrospektif analiz olarak dizayn edildi ve hastalara ait veriler hastane kayıtlarından toplandı. Hastaların 28'ine standart biatriyal, 33'üne bikaval anastomoz...

Risk factors and survival of patients with permanent pacemaker implantation after heart transplantation

“…The initial standard technique for HTX, also known as the biatrial technique, has been associated with elevated rates of PPM implantation due to a continuous circular suture of the right donor and recipient atrium with possible sinus node injury (2,4,(8)(9)(10). In contrast, the bicaval technique uses two donor-to-recipient vena cava anastomoses preserving the right atrial (RA) integrity and the sinus node (2,4).…”

Atrial electromechanical delay in patients undergoing heart transplantation

“…Extensive incision lines applied to atrial tissue may create electrophysiological instability by disturbing action potential propagation velocity and homogeneous distribution, thus creating a tendency to AF after using the biatrial technique. Owing to more extensive surgery lines, a temporary pacemaker requirement, left bundle branch block, and atrioventricular block were also observed statistically more significantly often compared to bicaval anastomosis [43] , [44] , [45] , [46] . In a study comparing the atrial arrhythmia incidence after both techniques, 31 bicaval and 35 biatrial operated patients were examined and the AF incidence were found to be significantly higher in the biatrial group (21 vs. 3 patients, p <0.01) [47] .…”

Over Ten Years of Experience with a Modified Right Atrial Anastomosis in Orthotopic Heart Transplantation: Follow-up and Comparison with the Biatrial and Bicaval Technique

“…Likewise, another modification of the bicaval technique has been given by Kitamura et al 5 Kara et al also reported, in a short postoperative followup analysis, lower rate of mitral or tricuspid valvular regurgitation and permanent pacemaker implantation by using bicaval technique compared with biatrial technique. 12 Another modification of the bicaval technique to reduce tricuspid valve regurgitation by modifying inferior vena caval anastomosis presented by Marelli et al also focuses on the influence of RA anterior wall stress through traditional bicaval technique. 6 Our modified RA anastomosis (cavoatrial technique) can be apprehended as a combination of the two traditional techniques.…”