Technical considerations of a new technique for orthotopic heart transplantation. Total excision of recipient's atria with bicaval and pulmonary venous anastomoses.

An alternative technique for orthotopic heart transplantation is described. It consists of total excision of the recipient's atria with donor heart transplantation performed using bicaval end-to-end anastomosis, as well as pulmonary venous anastomoses. Thus, total atrial as well as ventricular transplantation is performed. This new surgical approach is technically simple and preserves the anatomic size, geometric configuration and physiologic function of the atria. This technique has the potential to improve the long-term hemodynamic results in heart transplant patients as it reduces the incidence of postoperative atrioventricular valve regurgitation. In addition, the incidence of early posttransplant bradyarrhythmias (within 4 to 6 weeks after transplantation) that require the insertion of a permanent pacemaker is also significantly reduced. This report describes some technical guidelines for harvesting the donor heart, as well as for the implantation of the cardiac allograft, in order to avoid the development of serious intraoperative and postoperative complications directly associated with this technique.