Congenital Heart Surgeons' Society

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Bicaval And Biatrial Techniques Have Equivalent Long Term Outcomes In Children Transplanted In The First Year Of Life
Timothy P. Martens, MD, PhD, Zachary Tran, MD, Peter Chau, MD, Matthew J. Bock, MD, Richard E. Chinnock, MD, Anees J. Razzouk, MD.
Loma Linda University, Loma Linda, CA, USA.

Objective(s): Neonatal and infant heart transplant often requires use of a biatrial technique to accommodate anatomic constraints. Some series have demonstrated a survival advantage for the bicaval technique in adults. We aim to compare both techniques in the neonatal and infant transplant population.
Methods: Retrospective review of all patients < 1 year of age undergoing orthotopic heart transplantation (1986-present) in a single center was conducted. Annual surveys and periodic phone follow-up captured survival and reintervention rates. Kaplan-Meier curves were used to compare survival and freedom from permanent pacemaker or SVC intervention between techniques.
Results: A total of 343 patients underwent biatrial (n=299) or bicaval (n=44) orthotopic heart transplant in the first year of life. A higher proportion of biatrial patients had congenital heart disease (88% vs 61%, p < 0.05) rather than a primary cardiomyopathy. There was no significant difference in post-transplant survival at 10 (72 vs 68%, biatrial vs bicaval) or 20 years (63 vs 59%, bicaval vs biatrial). Freedom from permanent pacemaker implant was similar between techniques at 5 (97.7 vs 97.0%, bicaval vs batrial) , 10 (97.7 vs 96.1%, bicaval vs biatrial), and 20 years (97.7 vs 94.3%). There was no difference in SVC stenosis requiring intervention between groups (1/44 bicaval patients vs. 2/299 biatrial patients, p = N.S.).
Conclusions: Bicaval and biatrial techniques offer equivalent long term outcomes in children undergoing heart transplant in the first year of life.