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Brief
Communication
Orthotopic
Heart
Transplantation
with
Bicaval
Anastomosis
Antonino
M.
Grande,
MD
Massimo
Pozzoli,
MD
Egidio
Traversi,
MD
Luigi
Martinelli,
MD
Gaetano
Minzioni,
MD
Andrea
M.
D'Armini,
MD
Mauro
Rinaldi,
MD
Mario
Vigan6,
MD
Key
words:
Automated
boundary
detection;
echocar-
diography,
two-dimensional;
heart
transplantation
From:
Divisione
di
Cardio-
chirurgia
(Drs.
Grande,
Martinelli,
Minzioni,
D'Armini,
Rinaldi,
and
Vigan6),
Istituto
di
Chirurgia
Generale
e
dei
Trapianti
d'Organo,
IRCCS
Policlinico
San
Matteo,
Universita
degli
Studi
Pavia,
27100
Pavia,
Italy;
and
Divisione
Cardi-
ologia
(Drs.
Pozzoli
and
Traversi),
Fondazione
Salvatore
Maugeri,
IRCCS
Centro
Medico
Montescano,
27040
Pavia,
Italy
Address
for
reprints:
Antonino
M.
Grande,
MD,
Divisione
di
Cardiochirurgia,
Istituto
di
Chirurgia
Generale
e
dei
Trapianti
d'Organo,
IRCCS
Policlinico
San
Matteo,
Piazzale
Golgi
2,
27100
Pavia,
Italy
A
t
our
institution,
437
heart
transplantations
have
been
performed
since
November
1985.
In
1995,
we
began
a
randomized
study,
performing
heart
transplantation
using
the
standard
technique
in
38
patients
and
a
bicaval
technique
in
35
patients.
In
this
preliminary
report,
we
present
the
bicaval
technique
as
an
alternative
method
of
orthotopic
cardiac
transplantation.
We
be-
lieve
this
to
be
superior
to
the
standard
technique,
because
the
bicaval
operation
better
preserves
the
right
and
left
atrial
anatomy
(Fig.
1).
Surgical
Technique.
In
the
recipient,
the
aorta
is
cannulated
near
the
base
of
the
brachiocephalic
trunk;
venous
cannulation
is
performed
in
both
venae
cavae.
The
right
atrium
is
completely
resected,
leaving
an
atrial
cuff
at
the
juncture
of
the
superior
and
inferior
venae
cavae.
The
donor
heart
is
excised
with
an
intact
right
atrium
and
a
long
segment
of
the
superior
vena
cava.
The
donor
left
atrium
is
sutured
to
the
stump
of
the
4
pulmonary
veins
in
the
recipient
with
continuous
3-0
Prolene
suture
(Ethicon,
Inc.;
Somerville,
NJ),
by
the
standard
technique.
The
superior
and
inferior
venae
cavae
are
sutured
to
the
recipient
atrial
cuff
with
4-0
Prolene
suture.
The
great
arteries
are
anastomosed
in
the
usual
fashion.
Echocardiographic
Results.
In
Figures
2
and
3,
we
present
postoperative,
api-
cal,
4-chambered,
2-dimensional
echocardiographic
views
with
automated
bound-
ary
detection
in
2
orthotopic
heart
transplant
patients
(patient
A,
standard
technique;
patient
B,
bicaval
technique).
The
areas
of
interest
are
drawn
around
the
right
and
left
atria;
the
corresponding
time/volume
curves
of
the
atria,
also
made
by
the
automated
boundary
detection
system,
are
displayed
beneath
each
echocardiographic
scan.
The
3
phases
of
atrial
function
are
shown
by
the
time/
Fig.
1
Orthotopic
heart
transplantation:
A)
standard
technique;
B)
bicaval
technique.
310
Orthotopic
Heart
Transplantation
Volume
Z3,
Ntimber
4,
1996
Fig.
2
Automated
boundary
detection
of
the
right
atrium:
Fig.
3
Automated
boundary
detection
of
the
left
atrium:
A)
standard;
B)
bicaval.
The
3
phases
of
atrial
function
are
A)
standard;
B)
bicaval.
As
in
Figure
2,
the
3
phases
of
atrial
shown
by
the
time/volume
curves.
Note
that,
in
comparison
function
are
shown
by
the
time/volume
curves.
Note
again
with
patient
A,
the
atrial
volume
is
lower
in
patient
B.
(The
that,
in
comparison
with
patient
A,
the
atrial
volume
is
lower
scale
is
larger
in
(Al.)
in
patient
B.
(The
scale
is
larger
in
[Al.)
R
=
reservoir;
C
=
passive
conduit;
P
=
active
pump
function
R
=
reservoir;
C
=
passive
conduit;
P
=
active
pump
function
volume
curves:
R
=
reservoir,
C
=
passive
conduit,
and
P
=
active
pump
function.
In
the
patient
who
has
undergone
the
bicaval
technique,
both
the
right
(Fig.
2B)
and
the
left
(Fig.
3B)
atrial
volumes
are
remarkably
smaller
and
the
relative
volume
changes
for
each
phase
are
much
greater
than
those
in
the
other
patient
(Fig.
2A
and
3A),
indicating
better
glob-
al
function
and
more
active
pump
function
as
a
re-
sult
of
bicaval
anastomosis.
We
conclude
that
maintaining
the
integrity
of
both
atria
by
the
bicaval
technique
improves
the
hemo-
dynamic
performance
in
orthotopic
heart
transplan-
tation
patients.
Orthotopic
Heart
Transplantation
311
Te-xas
Heart
Instituteiournal
