[The surgical technic in the orthotopic heart transplant].

Surgical technique of the orthotopic heart transplantation, described in 1961, almost has not been modified since then, due to its efficiency, simplicity, short-time consuming procedure with satisfactory clinical results. Several authors have recently pointed out on the presence of atrioventricular valves insufficiency produces by the distortion of the atrial anatomy and valve function with the standard surgical procedure. A radical technique has been proposed, consisting on a bicaval direct anastomosis after recipient total atrial resection. This operation reduces the supraventricular arrhythmias and the tricuspid and mitral valves incompetence, with hemodynamic and exercise tolerance improvement. Additional clinical studies are necessary to demonstrate the superiority of the radical technique over the standard procedure of heart transplantation.