Hemodynamic and echocardiographic evaluation of orthotopic heart transplantation with the modified bicaval anastomosis technique.

BACKGROUND

The purpose of this study was to evaluate the hemodynamic and echocardiographic function of hearts transplanted with the modified bicaval anastomosis technique (mBCAT).

METHODS AND RESULTS

Twenty consecutive patients (14 males, 6 females, age range 14-61 [41.3 +/-11.5 years]) were evaluated 3.4 +/-2.2 years after heart transplantation using the mBCAT. All patients were in status I on the waiting list, and 18 (90%) had had a left ventricular assist device. The donor age was 39 +/-12 years. Triple immunosuppressive regimen and cardiac biopsy were routinely performed. There was no hospital mortality. One death occurred 4.2 years after the operation because of bone marrow dysplasia and infection. The 8-year survival was 89% (95% confidence interval: 0.43-0.98). All the hemodynamic variables returned to the normal range. Low right atrial pressure (3.2 +/-1.5 mmHg) and low pulmonary wedge pressure (6.7 +/-2.1 mmHg) were associated with an excellent cardiac index (3.9 +/-0.7 L . min(-1) . m(-2)). Echocardiography revealed an excellent late peak velocity (52 +/-19 cm/s) and an E/A ratio (1.4 +/-0.6) of tricuspid flow. The grade (0-4) of tricuspid regurgitation averaged 1.5 +/-0.8.

CONCLUSIONS

Hemodynamic and echocardiographic results for mBCAT were excellent. The 8-year survival was 89% with all surviving patients in New York Heart Association class I. The mBCAT is easy to perform and further facilitates cardiac transplantation.