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Ann Thorac Surg 1995;59:1495-1500
© 1995 The Society of Thoracic Surgeons

Articles

Cardiovascular dynamics and dimensions after bicaval and standard cardiac transplantation

MD Rainer G. Leyh*, MD Andres W. Jahnke, MD Ernst G. Kraatz, PhD Hans-H. Sievers

Department of Cardiovascular Surgery, University of Kiel, Kiel, Germany

Accepted for publication February 22, 1995.

* Address reprint requests to Dr Leyh, Klinik für Herzchirurgie der Universitätsklinik Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.


   Abstract
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 Abstract
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Bicaval orthotopic cardiac transplantation leaving the right atrium intact has been introduced recently into clinical practice as an alternative to the standard method. To determine the effect of the surgical technique, 27 patients were studied at rest and supine exercise 19 ± 5 months after bicaval orthotopic cardiac transplantation (group A, n = 15) and 22 ± 7 months after standard orthotopic cardiac transplantation (group B, n = 12). Resting hemodynamics showed no difference between groups. With exercise, a significantly higher right atrial pressure was noted in group B. Echocardiographic analysis showed asynchronous right atrial contraction in 83% of group B patients versus none in group A. Resting right ventricular dimensions were significantly greater in group B (right ventricular end-diastolic diameter, 3.27 ± 0.44 cm versus 2.88 ± 0.35 cm [p < 0.05]; right ventricular end-diastolic area, 21.3 ± 2.85 cm2 versus 17.1 ± 2.01 cm2 [p < 0.005]). A higher incidence and significantly higher grade of tricuspid regurgitation were found throughout exercise in group B. The exercise duration (17.34 ± 3.53 minutes versus 14.04 ± 4.11 minutes [p < 0.05]) and the exercise capacity (1.17 ± 0.25 W/kg versus 0.93 ± 0.34 W/kg [p < 0.05]) were increased in group A. These data provide some evidence that the bicaval technique of cardiac transplantation improves cardiovascular dynamics and dimensions as well as exercise capacity.


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 Abstract
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