Influence of different implantation techniques on AV valve competence after orthotopic heart transplantation.

OBJECTIVE

About a decade after the introduction of the bicaval and pulmaonary venous heart transplantation technique a reduction of tricuspid and mitral valve incompetence compared to the standard technique by Lower and Shumway is still discussed controversially. We used this technique regularly since the year 1993 and report about our 10 years experience.

METHODS

A total of 297 patients were transplanted at our institution between 1989 and 2003, 158 with the standard and 139 in the total orthotopic technique (TOHT). Ninety-four of the standard and 72 of the TOHT group were followed up as outpatients and were examined with right-heart catheterisation and trans-thoracic echocardiography.

RESULTS

Patients in both groups were similar in demographic data. Right heart catheterisation showed no statistical significant differences between the two groups. The left atrium was significantly enlarged in the standard group. The TOHT group showed a significant reduction of tricuspid regurgitation in 5-year follow up echocardiography.

CONCLUSION

This study showed excellent long-term survival rates for both groups. The significant reduction of left atrial size and atrio-ventricular valve regurgitation in the TOHT group might have important impact on the long-term preservation of cardiac function. Total orthotopic heart transplantation with bicaval and pulmonary venous anastomosis should be preferred for heart transplantation.