Evaluation of early postoperative results after bicaval versus standard cardiac transplantation and review of the literature

Objective: Previous studies have been inconsistent in defining a clinical benefit to the bicaval cardiac transplantation technique relative to the standard technique, and many major centers have not adopted this newer approach. The purpose of this study was to determine whether clinically significant benefits support utilization of the bicaval technique. Methods: Sixty-eight consecutive adult patients undergoing a standard cardiac transplant were compared with 75 consecutive patients who underwent the bicaval technique during the period from 1991 to 1999. Etiology, recipient sex, recipient age, donor age, and pulmonary vascular resistance were similar between the two groups. Results: Cardiac index at 24 hours after operation was increased for the bicaval group relative to the standard group (3.15 ± 0.7 vs 2.7 ± 0.5 L/min/m², P < .05). Inotropic requirements were significantly less, and there was significantly less tricuspid regurgitation in the bicaval group relative to the standard grouls. In addition, the bicaval group more frequently had a nonpaced normal sihus rhythm at 24 hours after operation (73.9% vs 50.7% [standard group], P = .025) and had fewer postoperative arrhythmias (29.3% vs 47.7% [standard group], P < .01). Finally, although mortality was similar for the two groups, length of postoperative hospitalization was longer for the standard group relative to the bicaval group (12.1 ± 11 vs 20.4 ± 12 days, P < .001). Review of the literature identified reduced tricuspid regurgitation and improved rhythm as consistent benefits of the bicaval technique. Conclusion: This review demonstrates a clinical benefit during the early postoperative period with bicaval cardiac transplantation (relative to standard) and encourages further utilization of this technique.