Application of modified bicaval technique for pediatric heart transplant with oversized donor heart


Whereas bicaval technique is an effective surgical method, standard bicaval technique for younger age and donor/recipient caval mismatch was reported to have a risk of superior vena caval obstruction. Between 2016 and 2019, three patients with dilated cardiomyopathy aged 10 years or younger underwent orthotropic heart transplantation with modified bicaval technique at our institute. Donor/recipient body weight and height ratios were 2.36, 0.77, and 2.61 and 1.37, 0.94, and 1.51, respectively. All patients were preoperatively supported by a left ventricular assist device: Excor Pediatric in two patients and Jarvik 2000 in one. Duration of LVAD support was 180, 238, and 220 days. One patient required revision of pulmonary anastomosis during the operation; accordingly, the chest was closed 3 days later. There was no mortality. Caval obstructions were not observed. Three months after the operation, tricuspid regurgitation was mild in two patients and trivial in one.

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  1. 1.

    Fernandez-Gonzales AL, Llorens R, Herreros JM, Di Stefano S, Barba J, Olavide I, et al. Intracardiac thrombi after orthotopic heart transplantation: clinical significance and etiologic factors. J Heart Lung Transpl. 1994;13:236–40.

    Google Scholar 

  2. 2.

    Jacob S, Sellke F. Is bicaval orthotopic heart transplantation superior to the biatrial technique? Interact Cardiovasc Thoracic Surg. 2009;9:333–42.

    Article  Google Scholar 

  3. 3.

    Aldoss O, Arain NI, Vinocur JM, Menk J, Ameduri RK, Bryant R 3rd, et al. Frequency of superior vena cava obstruction in pediatric heart transplant recipients and its relation to previous superior cavopulmonary anastomosis. Am J Cardiol. 2013;112:286–91.

    Article  Google Scholar 

  4. 4.

    Kitamura S, Nakatani T, Bando K, Sasako Y, Kobayashi J, Yagihara T. Modification of bicaval anastomosis technique for orthotopic heart transplantation. Ann Thorac Surg. 2001;72:1405–6.

    CAS  Article  Google Scholar 

  5. 5.

    Kim HR, Jung SH, Kim JJ, Yang DH, Yun TJ, Lee JW. Modified bicaval technique in orthotopic heart transplantation—comparison with conventional bicaval technique. Circ J. 2018;83:117–21.

    Article  Google Scholar 

  6. 6.

    Schnoor M, Schäfer T, Lühmann D, Sievers HH. Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2007;134:1322–31.

    Article  Google Scholar 

  7. 7.

    Coskun O, Parsa A, Coskun T, El Arousy M, Blanz U, von Knyphausen E, et al. Outcome of heart transplantation in pediatric recipients. ASAIO J. 2007;53:107–10.

    Article  Google Scholar 

  8. 8.

    Salavitabar A, Flyer JN, Torres AJ, Richmond ME, Crystal MA, Turner ME, et al. Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: a single-center experience assessing risk factors and outcomes. Pediatr Transplant. 2018;22:e13267.

    Article  Google Scholar 

  9. 9.

    Patel ND, Weiss ES, Nwakanma LU, Russell SD, Baumgartner WA, Shah AS, et al. Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the United Network for Organ Sharing Database. Circulation. 2008;118:S83–8.

    Article  Google Scholar 

  10. 10.

    Reichart B. Size matching in heart transplantation. J Heart Lung Transpl. 1992;11:S199–202.

    CAS  Google Scholar 

  11. 11.

    Kanani M, Hoskote A, Carter C, Burch M, Tsang V, Kostolny M. Increasing donor-recipient weight mismatch in pediatric orthotopic heart transplantation does not adversely affect outcome. Eur J Cardiothorac Surg. 2012;41:427–34.

    Article  Google Scholar 

  12. 12.

    Patel A, Bock MJ, Wollstein A, Nguyen K, Malerba S, Lytrivi ID. Donor-recipient height ratio and outcomes in pediatric heart transplantation. Pediatr Transpl. 2016;20:652–7.

    Article  Google Scholar 

  13. 13.

    Ueno T, Fukushima N, Sakaguchi T, Ide H, Ozawa H, Saito S, et al. First pediatric heart transplantation from a pediatric donor heart in Japan. Circ J. 2012;76:752–4.

    CAS  Article  Google Scholar 

  14. 14.

    The Japan society for transplantation factbook 2018. (In Japanese)

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Correspondence to Takaya Hoashi.

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Hoashi, T., Sakaguchi, H., Shimada, M. et al. Application of modified bicaval technique for pediatric heart transplant with oversized donor heart. Gen Thorac Cardiovasc Surg 68, 1329–1332 (2020).

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  • Pediatric heart transplantation
  • Modified bicaval technique