Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
J Thorac Cardiovasc Surg. 2010 Sep;140(3):700-8, 708.e1-2. doi: 10.1016/j.jtcvs.2010.04.029. Epub 2010 Jun 26.
Most studies of anastomotic technique have been underpowered to detect subtle differences in survival. We analyzed the United Network for Organ Sharing database for trends in use and outcomes after either bicaval or traditional (biatrial) anastomoses for heart implantation.
Review of United Network for Organ Sharing data identified 20,999 recipients of heart transplants from 1997 to 2007. Patients were stratified based on the technique of atrial anastomosis: standard biatrial (atrial group, n = 11,919, 59.3%), bicaval (caval group, n = 7661, 38.1%), or total orthotopic (total group, n = 519, 2.6%).
The use of the bicaval anastomosis is increasing, but many transplantations continue to use a biatrial anastomosis (1997, 0.2% vs 97.6%; 2007, 62.0% vs 34.7%; P < .0001). Atrial group patients required permanent pacemaker implantation more often (odds ratio, 2.6; 95% confidence interval, 2.2-3.1). Caval group patients had a significant advantage in 30-day mortality (odds ratio, 0.83; 95% confidence interval, 0.75-0.93), and Cox regression analysis confirmed the decreased long-term survival in the atrial group (hazard ratio, 1.11; 95% confidence interval, 1.04-1.19).
Heart transplantations performed with bicaval anastomoses require postoperative permanent pacemaker implantation at lower frequency and have a small but significant survival advantage compared with biatrial anastomoses. We recommend that except where technical considerations require a biatrial technique, bicaval anastomoses should be performed for heart transplantation.
大多数吻合技术的研究都因缺乏效力而无法检测到生存方面的细微差异。我们分析了美国器官共享网络数据库，以了解在心脏移植中使用双腔静脉或传统（双心房）吻合术的趋势及其结果。
对美国器官共享网络数据库进行回顾，确定了 1997 年至 2007 年间接受心脏移植的 20999 名患者。根据心房吻合技术将患者分层：标准双心房（心房组，n = 11919，59.3%）、双腔静脉（腔静脉组，n = 7661，38.1%）或全正交（全组，n = 519，2.6%）。
双腔静脉吻合术的使用正在增加，但许多心脏移植仍在使用双心房吻合术（1997 年，0.2%对 97.6%；2007 年，62.0%对 34.7%；P < 0.0001）。心房组患者更常需要植入永久性起搏器（优势比，2.6；95%置信区间，2.2-3.1）。腔静脉组患者在 30 天死亡率方面具有显著优势（优势比，0.83；95%置信区间，0.75-0.93），Cox 回归分析证实心房组的长期生存率降低（风险比，1.11；95%置信区间，1.04-1.19）。
与双心房吻合术相比，使用双腔静脉吻合术进行心脏移植术后需要植入永久性起搏器的频率较低，并且具有较小但显著的生存优势。我们建议，除非技术因素需要双心房技术，否则应进行双腔静脉吻合术用于心脏移植。
