Orthotopic cardiac transplantation: A comparison of standard and bicaval Wythenshawe techniques

Abstract

We describe an alternative technique for orthotopic cardiac transplantation (bicaval Wythenshawe technique), which maintains the right and left atrial anatomy. We compared the new bicaval technique with the conventional (Lower and Shumway) technique of orthotopic cardiac transplantation to identify any beneficial physiologic and clinical outcomes resulting from maintaining the normal anatomy. Seventy-five patients were randomized on an alternate basis to two groups: group A (n = 40) had orthotopic cardiac transplantation with the bicaval technique and group B (n = 35) had conventional orthotopic heart transplantation. All patients were studied with transthoracic echocardiogram, endomyocardial biopsies, and measurement of intracardiac pressures 1, 4, and 12 weeks after transplantation. There were no statistically significant differences in the demographic profile, ischemic time, bypass time, implantation time, transpulmonary gradient, or pulmonary vascular resistance between the two groups. The hemodynamic data were collected in the absence of histologic signs of rejection. In group A right atrial pressure (mean 3.6 mm Hg) was significantly lower (p < 0.03) than in group B (mean 8.8 mm Hg). The right atrial a wave was recorded in 38 patients in group A compared with seven patients in group B (p = 0.041). Atrial tachyarrhythmias occurred in two patients in group A compared with 11 in group B (p < 0.016). Temporary pacing was required in 10 patients in group A and 16 patients in group B (p = 0.034). Four cases of mitral regurgitation (all mild) were detected in group A in comparison with 12 cases (10 mild, 2 severe) in group B (p = 0.008). The mean ejection fraction in the first week after transplantation was 58% in group A and 46% in group B (p = 0.5). In the first 3 months the need for diuretics was less in group A (mean dose 80.8 mg furosemide daily) than in group B (mean dose 134 mg furosemide daily in the first week increasing to 160 mg furosemide daily). Hospital stay was shorter in group A (mean 23 days) than in group B (mean 27 days) (p < 0.015). There were no early deaths as a result of right ventricular failure in group A (n = 0/40) compared with four (n = 4/35; 9%) in group B (p < 0.034). This difference suggests that bicaval orthotopic cardiac implantation is associated with a lower right atrial pressure, a lower likelihood of atrial tachyarrhythmias, less need for pacing, less mitral incompetence, a lower diuretic dose, and a shorter hospital stay.(ABSTRACT TRUNCATED AT 400 WORDS)

New conduction defects and pacemaker implantation after heart transplantation

“…[17] In two randomized trials, permanent pacing was not required in any patients undergoing bicaval anastomosis, but in five (6.7%) of 75 patients undergoing biatrial anastomosis. [18,19] Our cohort was comprised of those undergoing biatrial orthotopic heart transplantation, and our results are in consistent with the literature data.…”

Transplante cardíaco no Instituto Dante Pazzanese de Cardiologia: análise da sobrevida

“…Entretanto, como demonstrado anteriormente em trabalho desta Instituição (29) e em outros relatos (30)(31)(32) , na técnica bicaval é menor a incidência de taquiarritmias e o uso de marcapasso definitivo, bem como é menor o índice de regurgitação mitral ou tricúspide (25,33) . Na nossa casuística, não temos nenhum paciente que necessitou de marcapasso definitivo após a técnica bicaval/bipulmonar, enquanto que há um após a técnica atrial.…”

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

“…El-Gamel et al (18) stated that in their 85 patient working groups, with the bicaval technique the right atrial pressure was lower, the atrial tachyarrhythmia was encountered less, the mitral incompetence was less and the diuretic dose need was less. Cui et al (19) in their studies reported that in the patients in which the biatrial anastomosis technique is used, the atrial flutter incidence was significantly high but the atrial fibrillation was similar in both technique.…”