A prospective randomized trial of complete atrioventricular transplantation versus ventricular transplantation with atrioplasty

Impaired exercise parameters in pediatric heart transplant recipients: Comparison of biatrial and bicaval techniques

“…In an adult study, despite unfavorable factors in the biatrial group such as higher RA pressure, a higher incidence of tricuspid insuf®ciency, and asynchronous RA contraction on echocardiography, exercise capacity was comparable to the bicaval group (22). Bainbridge and colleagues recently reported a randomized study of 58 adult transplant recipients, 29 had biatrial and 29 had bicaval, and con®rmed our ®ndings of similar peak oxygen consumption and peak heart rates (23). In summary, pediatric heart transplant patients have lower exercise capacities and peak heart rates than normal children despite favorable resting hemodynamics and left ventricular ejection fractions.…”

Outcomes in Bicaval Versus Biatrial Techniques in Heart Transplantation: An Analysis of the UNOS Database

“…5,6 The new method was used by Dreyfus et al 2 in 1991, and then adopted to a bicaval technique and formally described in two separate clinical series by Sievers et al 4 and Sarsam et al 3 Although concerns exist for complica- tions related to caval anastomoses (IVC and SVC stenoses), studies have shown a clear advantage for the bicaval technique in terms of improved peri-operative hemodynamics, 15 superior atrial function, 7,8 less tricuspid regurgitation [11][12][13] and decreased arrhythmias. 10,16 Whether a survival benefit exists with the bicaval technique is less clear.…”

“…[2][3][4][5][6] Studies comparing the two techniques have shown that the bicaval anastomotic technique leads to improved atrial function, 7,8 lower rate of post-operative arrhythmias, 9 decreased need for permanent pacing, 10 decreased tricuspid regurgitation, [11][12][13] and in one series improved survival. 14 As a result of this perceived superiority, the number of heart transplants conducted with the bicaval technique has increased steadily since 1995.…”

Donor Tricuspid Annuloplasty During Orthotopic Heart Transplantation: Long-Term Results of a Prospective Controlled Study

“…This difference is attributed to alteration in the geometry of the tricuspid valve and right atrium related to the technique of right atrial anastomosis. Other possible causes of TR include: 1) allograft dysfunction with right ventricular dilatation due to poor preservation, reperfusion injury, donor factors, or rejection, 2) pulmonary hypertension, 3) severe donor recipient size mismatch, and 4) structural damage occurring during endomyocardial biopsy [6,7,8,9,10].…”