Standard versus bicaval techniques for orthotopic heart transplantation

An analysis of the United Network for Organ Sharing database

Ryan R Davies, Mark J. Russo, Jeffrey A. Morgan, Robert A. Sorabella, Yoshifumi Naka, Jonathan M. Chen

Research output: Contribution to journalArticle

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Abstract

Objective: 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. Methods: 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%). Results: 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). Conclusions: 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.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number3
DOIs
StatePublished - Sep 1 2010

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Heart Transplantation
Venae Cavae
Databases
Confidence Intervals
Survival
Odds Ratio
Information Dissemination
Transplantation
Regression Analysis
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Standard versus bicaval techniques for orthotopic heart transplantation : An analysis of the United Network for Organ Sharing database. / Davies, Ryan R; Russo, Mark J.; Morgan, Jeffrey A.; Sorabella, Robert A.; Naka, Yoshifumi; Chen, Jonathan M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No. 3, 01.09.2010.

Research output: Contribution to journalArticle

Davies, Ryan R ; Russo, Mark J. ; Morgan, Jeffrey A. ; Sorabella, Robert A. ; Naka, Yoshifumi ; Chen, Jonathan M. / Standard versus bicaval techniques for orthotopic heart transplantation : An analysis of the United Network for Organ Sharing database. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 140, No. 3.
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