Ann Thorac Surg 2005;80:789
© 2005 The Society of Thoracic Surgeons
Correspondence
Orthotopic Cardiac Transplantation: Modification of Bicaval Anastomosis
Nikolaos B. Tsilimingas, MD
Department of Thoracic and Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Martinistr 52, Hamburg 20246, Germany
(Email: tsilimingas{at}uke.uni-hamburg.de).
To the Editor:
I thank Dr Kitamura [1] for his letter to the editor regarding my article that appeared in the April 2003 issue of The Annals of Thoracic Surgery [2]. I would like to make the following comments.
Independently, since January 1998, perhaps earlier, we realized that the anatomy of the right atrium could be stabilized by leaving a bridge between the venae cavae. So I was pleased that Dr Kitamura and associates [1] felt similarly. I enjoyed the Dr Kitamura and associates’ article [3], and I am confident that neither the title nor the text are the same. The only aspect in common was and still remains to be is in our efforts to prevent tension, torsion, and kinking of the bicaval anastomosis.
In contrast to their published technique (four cases as redo operations), my modified technique was utilized at both redo operations and consequently as routine. We performed this method consistently in 31 consecutive patients since 1998. However, I see important differences in constructing the anastomosis; I have described and illustrated these differences in my detailed figures using the term "telescopic technique." This technique produces another functional difference: the caval anastomoses are not performed in the junction area of the superior venae cavae with the right atrium, as by Dr Kitamura and associates’ [3] technique, but rather are more peripheral so that the sinus node is not irritated and therefore function is better preserved. I think this is the crux of our differences.
Finally, I would like to thank Dr Kitamura for his commentary [1], with which he has given me the opportunity to once again clearly illustrate these important technical differences.
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References
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- Kitamura S. Modification of bicaval anastomosis for orthotopic cardiac transplantation Ann Thorac Surg 2004;78:1130.[Free Full Text]
- Tsilimingas NB. Modification of bicaval anastomosisan alternative technique for orthotopic cardiac transplantation. Ann Thorac Surg 2003;75:1333-1334.[Abstract/Free Full Text]
- Kitamura S, Nakatani T, Bando K, Sasako Y, Kobayashi J, Yagihara T. Modification of bicaval anastomosis technique for orthotopic heart transplantation Ann Thorac Surg 2001;72:1405-1406.[Abstract/Free Full Text]
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