This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Samuel Jacob Frank Sellke Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jacob, S. Articles by Sellke, F. Search for Related Content PubMed PubMed Citation Articles by Jacob, S. Articles by Sellke, F.

Is bicaval orthotopic heart transplantation superior to the biatrial technique?

^a Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
^b Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA

*Corresponding author. Tel.: +1 713 2569045.

E-mail address: drsamueljacob{at}doctors.org.uk (S. Jacob).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the bicaval heart transplantation technique is superior to biatrial orthotopic heart transplantation (OHT). Altogether, 175 papers were found using the reported search, of which 20 presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that many papers have documented the superiority of the bicaval technique over the biatrial technique for short-term outcomes. A meta-analysis of 41 papers on this topic found significant benefits for early atrial pressure, tricuspid valve regurgitation, return to sinus rhythm and even perioperative mortality. But for longer-term outcome, the largest series of 11,931 patients found no difference in survival between the two groups and the meta-analysis found no mortality differences at 1 or 3 years. The bicaval technique is also more demanding technically and has a slightly longer bypass and ischaemic time. The United Network for Organ Sharing (UNOS) database showed that in 2005 in the USA the bicaval technique has now become more popular than the biatrial technique (1083 procedures vs. 806).

Key Words: Evidence-based medicine; Orthotopic transplantation; Bicaval anastomosis; Biatrial anastomosis; Survival; Arrhythmia