Trento A, Czer L S, Blanche C
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):126-32.
The surgical technique for cardiac transplantation was introduced by Lower and Shumway more than 30 years ago. It is known as "biatrial technique for cardiac transplantation" and has been used in more than 20,000 patients. However, since the early days of cardiac transplantation, atrial arrhythmias and atrioventricular conduction disturbances were noted so frequently that Dr. Barnard suggested a modification of the original technique to the present biatrial technique, in which the inferior vena cava orifice is enlarged with an atriotomy incision curving toward the base of the right atrial appendage, away from the sinus node. Atrial arrhythmias and other conduction abnormalities have, however, persisted and have resulted in the need for pacemaker insertion in a significant number of patients. Over the past years, with the more frequent use of transthoracic and transesophageal echocardiography, other abnormalities have been noted on follow-up of transplanted patients. These include tricuspid and mitral regurgitation, enlarged left and right atria with thrombus formation in the atrial suture line, asynchronous contraction of donor and recipient's atria, and right ventricular dysfunction in the early postoperative period. In the last 5 years, a new surgical technique for cardiac transplantation has been used in a few centers. This technique requires total excision of the recipient's heart and individual's caval and pulmonary vein anastomosis, "bicaval technique for cardiac transplantation." This technique seems to avoid the problems encountered with the biatrial technique. A comparison of the two surgical techniques, based on recently published surgical series, is presented.
30多年前，洛厄尔和舒姆韦介绍了心脏移植的手术技术。它被称为“心脏移植双心房技术”，已应用于2万多名患者。然而，自心脏移植早期以来，心房心律失常和房室传导障碍就经常被注意到，以至于巴纳德医生建议对原始技术进行改进，形成了目前的双心房技术，即通过一个朝着右心耳基部弯曲、远离窦房结的心房切开切口来扩大下腔静脉口。然而，心房心律失常和其他传导异常仍然存在，导致大量患者需要植入起搏器。在过去几年中，随着经胸和经食管超声心动图的更频繁使用，在移植患者的随访中发现了其他异常情况。这些异常包括三尖瓣和二尖瓣反流、左心房和右心房扩大并伴有心房缝合线处血栓形成、供体和受体心房的不同步收缩以及术后早期右心室功能障碍。在过去5年中，一种新的心脏移植手术技术已在一些中心使用。该技术需要完全切除受体心脏并进行个体腔静脉和肺静脉吻合，即“心脏移植双腔静脉技术”。这种技术似乎避免了双心房技术所遇到的问题。本文根据最近发表的手术系列对这两种手术技术进行了比较。
