Heart transplantation has progressed significantly in the 50 years since Lower and Shumway described the technical aspects of the procedure. The surgical technique evolved into an orthotropic approach and progressed from the relatively easier biatrial technique to bicaval anastomotic procedure. As of 2007 most transplants in the USA are completed with a bicaval anastomosis. This chapter provides a detailed description of the bicaval technique most commonly performed in the USA and with specific tips practiced at our institution. The recipient operation is approached most of the time through a median sternotomy, including in re-operative procedures. We initiate the terminal cardiectomy when we ensure that the donor team has safely landed. Allograft implantation proceeds with the left atrial anastomosis followed by the IVC and aortic anastomoses. Lastly the PA and SVC anastomoses are completed on beating or arrested heart.
KeywordsInferior Vena Cava Pulmonary Vein Right Ventricle Superior Vena Cava Left Ventricular Assist Device
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