Improved left atrial transport and function with orthotopic heart transplantation by bicaval and pulmonary venous anastomoses

Dov Freimark, Lawrence S.C. Czer*, Ivan Aleksic, Cord Barthold, Dan Admon, Alfredo Trento, Carlos Blanche, Mario Valenza, Robert J. Siegel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Orthotopic heart transplantation (OHT) with bicaval and pulmonary venous anastomoses avoids the large atrial anastomoses of the standard biatrial technique. To determine whether the bicaval technique improves atrial performance, we used Doppler echocardiography to study 13 patients with bicaval OHT, 15 with biatrial OHT, and 8 normal subjects. All were in sinus rhythm and free of rejection. Left atrial size, transmitral (M) and late diastolic (A) mitral flow velocity integrals were measured. Atrial transport (A/M, %) and atrial ejection force (kilodynes, calculated from peak A-wave velocity and mitral orifice area) were assessed. Left atrial dimensions in the bicaval (4.3 ± 0.5 cm) and biatrial groups (4.9 ± 0.9 cm) were larger than in controls (3.3 ± 0.8 cm, p < 0.05). Left atrial transport (37% ± 12% and 35% ± 12%) and ejection force (14.1 ± 6.9 kdyne and 10.2 ± 7.8 kdyne) were similar in the bicaval group and controls (p not significant) but were significantly lower in the biatrial group (20% ± 19% and 3.6 ± 4.0 kdynes, p < 0.05). The bicaval and pulmonary venous technique of OHT produces more physiologic atrial function compared with the biatrial technique as evidenced by greater atrial ejection force and more normal atrial transport.

Original languageEnglish
Pages (from-to)121-126
Number of pages6
JournalAmerican Heart Journal
Volume130
Issue number1
DOIs
StatePublished - Jul 1995
Externally publishedYes

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