ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
ANALYSIS OF SURGICAL TECHNIQUES FOR HEART TRANSPLANTATION
Şeref Alp Küçüker1, Mehmet Ali Özatik1, Onurcan Tarcan1, Haşmet Bardakçı1, Omaç Tüfekçioğlu2, Nevzat Erdil1, İyad Fansa1, Kamil Göl1, Kerem Vural1, Süha Küçükaksu1, Binali Mavitaş1, Erol Şener1, Oğuz Taşdemir1
1Türkiye Yüksek İhtisas Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara
2Türkiye Yüksek İhtisas Hastanesi, Kardiyoloji Kliniği, Ankara
Background: Most effective treatment of end stage heart failure is cardiac transplantation. Standard biatrial cuff technique is the most widely used method for heart transplantation but alternative techniques such as bicaval anastomosis have been proposed in order to improve postoperative physiologic and clinical parameters. This study aims to evaluate early postoperative outcomes of patients recieving cardiac transplantation with both standart and bicaval anasthomosis techniques.

Methods: Between May 1998 and July 2002 19 patients had cardiac transplantation in our clinic, first eight patients with biatrial cuff (standard) technique and last 11 patients with bicaval technique. Eighteen patients (%94.7) were male and one patient (%6.3) was female and their mean age was 40 ± 11 years. Fourteen patients had dilated and five had ischemic cardiomyopathy. Six patients had major cardiac operation previously. Three had coronary bypass operation, one had Batista procedure, one had cardiomyoplasty and one had left ventricular assist device (DeBakey axial flow pump) inserted for bridging to cardiac transplantation. Mean cardiopulmonary bypass and mean cros clamp times were 130 ± 39 and 64 ± 7 minutes for standard group and 123 ± 28 and 67 ± 10 minutes for bicaval group, respectively. All patients were followed for a mean period of 18.2 ± 16 months (ranged 2 to 52 months).

Results: Two patients among standart group needed transient pace maker stimulation. Two other patients in the same group had atrial and ventricular arythmias requiring medical interventions. None of the patients had arythmias or required pace maker stimulation in the bicaval group. Early mortality occurred in two patients in standard group, one with right heart failure and the other with acute rejection. One patient was lost in the bicaval group in the early postoperative period due to multi organ failure. Echocardiographic controls in the early postoperative period revealed 2 ° tricuspid insufficiency in one patient, 1 ° tricuspid insufficiency in one patient, and minimal tricuspid insufficiency in three patient all in the standard group. Only two patients had minimal tricuspit insufficiency in the bicaval group.

Conclusions: To avoid right ventricular insufficiency and subsequent problems observed early after transplantation we use bicaval anasthomosis technique for cardiac transplantation. We observing that right sided hemodynamic variables were better preserved, cardiac rhythm recovered earlier and due to better preservation of right atrial morphology tricuspid insufficiency was rare when compared with standard anastomosis. Due to its observed benefits bicaval technique has became the technique of choice for cardiac transplantation in our clinic.

Keywords : Heart transplantation, bicaval technique, arhythmia, tricuspid insufficiency, cardiomyophaty
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