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Ann Thorac Surg 1995;60:282-283
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 275.

DR CARLOS BLANCHE (Los Angeles, CA): I congratulate Dr Bittner on this most elegant animal study. This is not a new technique for orthotoptic heart transplantation, however, as it was described by Cass and Brock in England in 1959 and in the United States by Webb in the same year. It was introduced into clinical practice by Professor Gilles Dreyfus in 1991. Since October 1991 we have used this new complete atrioventricular technique for all our orthotopic heart transplantations, and to date we have performed 80 such transplantations.

We have seen significant hemodynamic improvement in our patients postoperatively, including a decreased incidence of mitral and tricuspid regurgitation, and we have basically eliminated the need for pacemaker implantation in the posttransplantation period.

There is a disadvantage to this alternative technique, however, and that is that it takes longer to perform. In our experience the ischemic time is prolonged by an average of 21 minutes. I agree with Dr Bittner that this is a more physiologic approach because there is no distortion of the atrium and it preserves the geometric configuration and anatomic size of the right and left atria.

DR BITTNER: Thank you, Dr Blanche. This technique actually was described in 1953 by Neptune, and also Drs Lower and Shumway have been very well aware of this technique. At that time, unfortunately, they did not proceed with extensive study of orthotopic transplantation because of the prolonged bypass times you just mentioned you have encountered in your patients. Sewing the anastomoses in a different order like . . . [Full Text of this Article]

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Complete Atrioventricular Cardiac Transplantation: Improved Performance Compared With the Standard Technique

Hartmuth B. Bittner, Simon W. H. Kendall, Edward P. Chen, Robert D. Davis, and Peter Van Trigt, III
Ann. Thorac. Surg. 1995 60: 275-282. [Abstract] [Full Text]

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