O transplante cardíaco biatrial deve ainda ser realizado? Metanálise

Abstract

.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 ...

The influence of surgical technique on early posttransplant atrial fibrillation — comparison of biatrial, bicaval, and total orthotopic heart transplantation

“…Some studies reported a higher mortality rate with BA-HTX,8,9 whereas other publications found no difference 5,20,21…”

“…In contrast, BC-HTX and TO-HTX preserved the geometry and conduction system of the right donor atrium, as well as these keep most of the left donor atrium intact 4,5. Consequently, a lower incidence of atrial arrhythmias compared to BA-HTX has been observed 8. However, differences in size of the left atrial diameter and the remaining left atrial tissue between the two previously mentioned techniques still exist.…”

“…A survival advantage in patients with BC-HTX or TO-HTX compared to BA-HTX has been controversially discussed in the literature 5,8,9,20,21. Some studies reported a higher mortality rate with BA-HTX,8,9 whereas other publications found no difference 5,20,21…”

“…“Total orthotopic (TO) HTX”, also known as “bicaval, bipulmonary venous technique”, was clinically introduced by Dreyfus et al7 This technique comprises the total excision of the recipient atria, except for two small pulmonary vein cuffs, which are separately integrated into the left donor atrium 4,8,9. The right donor atrium is connected via BC anastomosis as reported by Sievers et al6 In this way, the anatomic integrity and physiology of both atria are preserved 9.…”

Cardiac Surgery After Heart Transplantation: Elective Operation or Last Exit Strategy?

“…This is in accordance with recent literature that has reported a higher rate of TR in biatrial implantation technique. 42 - 44 Sun et al 43 showed a significant higher rate of TR in patients with biatrial technique, and Goerler et al 5 reported that all but 1 case with tricuspid surgery occurred in patients transplanted in biatrial technique.…”