Hemodynamic and echocardiographic evaluation of orthotopic heart transplantation with the modified bicaval anastomosis technique

Background: The purpose of this study was to evaluate the hemodynamic and echocardiographic function of hearts transplanted with the modified bicaval anastomosis technique (mBCAT). Methods and Results: Twenty consecutive patients (14 males, 6 females, age range 14-61 [41.3±11.5 years]) were evaluated 3.4±2.2 years after heart transplantation using the mBCAT. All patients were in status I on the waiting list, and 18 (90%) had had a left ventricular assist device. The donor age was 39±12 years. Triple immunosuppressive regimen and cardiac biopsy were routinely performed. There was no hospital mortality. One death occurred 4.2 years after the operation because of bone marrow dysplasia and infection. The 8-year survival was 89% (95% confidence interval: 0.43-0.98). All the hemodynamic variables returned to the normal range. Low right atrial pressure (3.2±1.5 mmHg) and low pulmonary wedge pressure (6.7±2.1 mmHg) were associated with an excellent cardiac index (3.9±0.7 L·min^-1-m^-2). Echocardiography revealed an excellent late peak velocity (52±19 cm/s) and an E/A ratio (1.4±0.6) of tricuspid flow. The grade (0-4) of tricuspid regurgitation averaged 1.5±0.8. Conclusions: Hemodynamic and echocardiographic results for mBCAT were excellent. The 8-year survival was 89% with all surviving patients in New York Heart Association class I. The mBCAT is easy to perform and further facilitates cardiac transplantation.