ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Early-term results of bicaval and biatrial techniques in orthotopic heart transplantation
İbrahim Kara1, Denyan Mansuroğlu2, Kaan Kırali2, Mustafa Güler2, Suat Nail Ömeroğlu2, Ercan Eren2, Mehmet Balkanay2, Mete Alp2, Gökhan İpek2, Ömer Işık2, Cevat Yakut2
1Göztepe Şafak Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye
2Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2012.045
Background: This study aims to evaluate early postoperative results of orthotopic heart transplantation using bicaval and biatrial technique.

Methods: Between September 1989 and December 2008, 61 patients who underwent orthotopic heart transplantation in our clinic were included. Patients were divided into two groups according to the surgical technique used. Standard biatrial anostomosis technique was performed on 28 patients (mean age 31.8±12.5 years; range 16 to 58 years), while bicaval anostomosis technique was performed on 33 patients (mean age 29.8±9.9 years; range 17 to 48 years). There was no significant difference between two groups with respect to the preoperative patient characteristics and demographic data. However, the incidence of pulmonary dysfunction (p<0.05) and renal dysfunction (p<0.05) were higher in biatrial group. Mean cross clamping and cardiopulmonary bypass time were 73.9±13.6 and 114.4±20.8 minutes in biatrial group and 77.4±15.1 and 127.7 ±19.5 minutes in bicaval group.

Results: It was observed that the necessity of temporary pacemaker (p<0.05), increasing incidence of branch block (p<0.01) and atrioventricular block (p<0.05) were significantly higher in biatrial group. One patient required permanent pacemaker and one other patient required intracardiac defibrillator (ICD) implantation. Postoperative echocardiographic examination revealed that the incidence of tricuspid (p<0.01) and mitral insufficiency (p<0.01) were lower in bicaval group compared to biatrial group. Right ventricular hemodynamic function was maintained better in patients who underwent orthotopic transplantation using bicaval technique. Arrhythmia (ventricular arrhytmia and early atrial pulse) and atrioventricular valve insufficiency were less observed in this patient group. Also rhythm returned to normal earlier in bicaval group than biatrial group.

Conclusion: With regard to the results which influence early morbidity, bicaval technique was superior to the biatrial technique. Due to its observed benefits, bicaval anastomosis technique has become the routine for orthotopic heart transplantation in our clinic.

Keywords : Arrhythmia; bicaval technique; orthotopic heart transplantation; standart technique
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