EXPERIENCE OF PERFORMING BIATRIAL AND BICAVAL ORTHOTOPIC HEART TRANSPLANTATIONS (CLINICAL OBSERVATION)

Abstract

The aim of the work: to publish the results of performing biatrial and bicaval orthotopic heart transplantations, focusing on the advantages and disadvantages, possible difficulties that may arise during their performance.

Materials and Methods. The article describes the experience of performing two orthotopic heart transplantations – biatrial and bicaval, two well-known and generally accepted methods. The features of the early postoperative period and the overall result of surgical radical treatment are also described.

Results. It was found that the more common method of transplantation is bicaval. Biatrial orthotopic heart transplantation, described by Shumvay, is used much less frequently. Known disadvantages of the latter are conduction disturbances in the form of complete atrioventricular block due to crossing of the conduction pathways during the formation of the right atrial anastomosis or weakness of the sinus node (the recipient remains with its degeneration or ischemia). With the bicaval technique, as a rule, rhythm disturbances are less common, which is associated with a “complete” transplantation including all structures of the right atrium, the donor sinus node. In our case, there were conduction disturbances in the form of complete atrioventricular block, which, however, was transient in nature and did not require the implantation of a permanent pacemaker. In the case of bicaval transplantation, there were no persistent conduction disturbances at all, as well as other rhythm disturbances.

Conclusions. In combination with a longer surgical suture line, the bicaval technique is technically more difficult, and in some cases longer than the biatrial one, which prolongs the time of ischemia of the donor organ and may worsen the overall outcome of the surgical treatment.