Bicaval and standard techniques in orthotopic heart transplantation: Medium-term experience in cardiac performance and survival

Aziz, Tarek; Burgess, Malcolm; Khafagy, Richard; Hann, Alison Wynn; Campbell, Colin; Rahman, A; Deiraniya, Abdul K.; Yonan, Nizar

doi:10.1016/s0022-5223(99)70150-9

Cited by 94 publications

(71 citation statements)

References 25 publications

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“…In this context, the rejection episodes can also be related to the degree of tricuspid valve regurgitation 21,57 . In 2002, Aziz et al 57 showed that individuals with moderate or severe tricuspid regurgitation have a higher number and intensity of rejection episodes 57 .…”

Section: Discussionmentioning

confidence: 99%

“…In 2002, Aziz et al 57 showed that individuals with moderate or severe tricuspid regurgitation have a higher number and intensity of rejection episodes 57 . On the other hand, the progression of cardiac cellular rejection may be acompanied by edema and papillary muscle dysfunction, or trigger asymmetrical right ventricular contractility and thus lead to tricuspid valve regurgitation 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the high hydrophillic property of the glucosaminoglycans present in the valve leaflet leads to increased oncotic pressure in the extracellular matrix during cellular rejection, thus causing edema and precluding adequate function 21 . However, in 2003, Aleksic et al 58 showed that patients undergoing total heart transplantation who develop rejection have less hemodynamic consequences than those undergoing biatrial transplantation 58 .…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism through which tricuspid regurgitation develops is multifactorial. There is an association of acute graft edema; papillary muscle dysfunction; preoperative annular dilatation; change in the right atrial anatomic geometry with subsequent worsening of the functional integrity of the valvular apparatus; lesion of the subvalvular apparatus during endomyocardial biopsy; cyclic atrial tortion during ventricular systole and diastole; and asynchronous contraction of the donor and recipient atrial compartments 21,57 . Additionally, in 2002, Aziz et al 57 showed that the survival of patients with moderate/severe tricuspid regurgitation is insatisfactory in comparison to that of patients with other degrees of valve regurgitation 57 .…”

Section: Discussionmentioning

confidence: 99%

“…In fact, there are evidences in the literature that better results are obtained with the two techniques described more recently [10][11][12][13][14][15][16][17][18][19][20][21] . However, these evidences are weak when considered alone, and thus do not ensure an adequate level of evidence, especially because most of them are from retrospective studies with small case series 11,14,[22][23][24][25] .…”

mentioning

confidence: 99%

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O transplante cardíaco biatrial deve ainda ser realizado? Metanálise

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et al. 2010

Arq. Bras. Cardiol.

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.standard, two other techniques -the total and bicaval transplantation, were developed with the aim of ensuring better anatomical and physiological graft adaptation and better postoperative outcomes [5][6][7][8][9] . In fact, there are evidences in the literature that better results are obtained with the two techniques described more recently [10][11][12][13][14][15][16][17][18][19][20][21] . However, these evidences are weak when considered alone, and thus do not ensure an adequate level of evidence, especially because most of them are from retrospective studies with small case series 11,14,[22][23][24][25] .For this reason, in 2007, Schnoor et al 10 conducted a metaanalysis with the purpose of increasing the statistical power of the evidences that the new techniques are better than the biatrial transplantation 10 . However, these authors excluded retrospective studies from the main assessments; they included the two more recent techniques in a single group and made a limited review of the literature. As such, relevant data may have not been included in the meta-analysis, thus making the evidence incomplete. For this reason, the objective of this study was to determine whether the techniques of total and bicaval heart transplantation are better than the biatrial technique, thus adding to Schnoor et al 10 results. Method Inclusion and exclusion criteria Study selectionProspective controlled studies were included, whether randomized or not. Description of the randomization techiques, masking and patient follow-up, as described in the respective methodology of the studies, were not considered as criteria for inclusion. Retrospective studies including control groups were also included.Studies whose designs did not meet these requirements, like case series and uncontrolled retrospective studies, narrative reviews and systematic reviews of the literature, case reports, letters, brief communications, and experimental animal studies were excluded. Additionally, studies whose results were incomplete, that is, those not reporting information on mean and standard deviation for continuous numeric variables and proportion of events occurred for nominal categorical variables, were also excluded. PatientsNo restrictions were made as to patient gender, age, and ethnicity, or as to the baseline heart diseases that led SummaryThe outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed™, Lilacs™, Web of Science™, Scirus™, Scopus™, Google Scholar™, and Scielo™ databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were ...

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