Influence of Different Implantation Techniques on Long-term Survival After Orthotopic Heart Transplantation

An Echocardiographic Study

Jing Ping Sun, Jianli Niu, Michael K. Banbury, Lingmei Zhou, David O. Taylor, Randall C. Starling, Mario J. Garcia, William J. Stewart, James D. Thomas

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Orthotopic heart transplantation (OHT) was initially done by the biatrial technique, although the bicaval technique has recently become more popular. The aim of this study was to compare OHT outcomes when using the bicaval technique vs the biatrial technique. Methods: A total of 615 patients were transplanted at the Cleveland Clinic Foundation from January 1993 and October 2003 (biatrial technique: n = 293; bicaval technique: n = 322). The average follow-up period was 4.2 ± 2.9 years (range 1 to 11 years). Patients who were supported with a left ventricular assist device (prior to transplant) and who could not be weaned off respiratory support were excluded. Results: Patients in both groups were similar with regard to pre-operative characteristics. The peri-operative mortality showed no statistical significant differences between the two groups. The left atrium was significantly more enlarged in the biatrial group. The bicaval group showed a significantly reduced incidence of tricuspid regurgitation. Survival at 10-year follow-up was 87.3% in the bicaval group and 79.9% in the biatrial group (p < 0.05). Left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) and moderate to severe tricuspid regurgitation were significant risk factors for death in both groups. The bicaval technique showed a significantly better mortality outcome. Conclusions: This study showed that the bicaval technique for OHT offers a better outcome than the biatrial technique. The significant reduction of left atrial size and atrioventricular valve regurgitation in the bicaval group may have a major impact on the long-term preservation of cardiac function and survival.

Original languageEnglish (US)
Pages (from-to)1243-1248
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume26
Issue number12
DOIs
StatePublished - Dec 2007
Externally publishedYes

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Heart Transplantation
Tricuspid Valve Insufficiency
Stroke Volume
Survival
Heart-Assist Devices
Mortality
Heart Atria
Transplants
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Influence of Different Implantation Techniques on Long-term Survival After Orthotopic Heart Transplantation : An Echocardiographic Study. / Sun, Jing Ping; Niu, Jianli; Banbury, Michael K.; Zhou, Lingmei; Taylor, David O.; Starling, Randall C.; Garcia, Mario J.; Stewart, William J.; Thomas, James D.

In: Journal of Heart and Lung Transplantation, Vol. 26, No. 12, 12.2007, p. 1243-1248.

Research output: Contribution to journalArticle

Sun, Jing Ping ; Niu, Jianli ; Banbury, Michael K. ; Zhou, Lingmei ; Taylor, David O. ; Starling, Randall C. ; Garcia, Mario J. ; Stewart, William J. ; Thomas, James D. / Influence of Different Implantation Techniques on Long-term Survival After Orthotopic Heart Transplantation : An Echocardiographic Study. In: Journal of Heart and Lung Transplantation. 2007 ; Vol. 26, No. 12. pp. 1243-1248.
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abstract = "Background: Orthotopic heart transplantation (OHT) was initially done by the biatrial technique, although the bicaval technique has recently become more popular. The aim of this study was to compare OHT outcomes when using the bicaval technique vs the biatrial technique. Methods: A total of 615 patients were transplanted at the Cleveland Clinic Foundation from January 1993 and October 2003 (biatrial technique: n = 293; bicaval technique: n = 322). The average follow-up period was 4.2 ± 2.9 years (range 1 to 11 years). Patients who were supported with a left ventricular assist device (prior to transplant) and who could not be weaned off respiratory support were excluded. Results: Patients in both groups were similar with regard to pre-operative characteristics. The peri-operative mortality showed no statistical significant differences between the two groups. The left atrium was significantly more enlarged in the biatrial group. The bicaval group showed a significantly reduced incidence of tricuspid regurgitation. Survival at 10-year follow-up was 87.3{\%} in the bicaval group and 79.9{\%} in the biatrial group (p < 0.05). Left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) and moderate to severe tricuspid regurgitation were significant risk factors for death in both groups. The bicaval technique showed a significantly better mortality outcome. Conclusions: This study showed that the bicaval technique for OHT offers a better outcome than the biatrial technique. The significant reduction of left atrial size and atrioventricular valve regurgitation in the bicaval group may have a major impact on the long-term preservation of cardiac function and survival.",
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