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Total atrioventricular cardiac transplantation preserves atrial systole and ventricular diastolic filling

Publication ,  Journal Article
Bittner, HB; Chen, EP; Kendall, SW; Craig, D; Van Trigt, P
Published in: Circulation
November 1, 1996

Background: Total orthotopic heart transplantation was recently introduced into clinical practice as an alternative technique for orthotopic cardiac transplantation. Total cardiac transplantation uses separate bicaval and left and right pulmonary anastomoses, whereas the standard technique of cardiac transplantation uses atrioplasty. Because the anatomic differences between total and standard orthotopic heart transplantation occur at the atrial level, this study compares atrial systolic function and biventricular filling (dV/dt) between the standard and total transplantation techniques. Methods and Results: Forty-eight mongrel canines (23 to 31 kg) were used for 12 total and 12 standard orthotopic cardiac transplantations. Right and left ventricular (RV/LV) function and AV synchrony were analyzed with micromanometry, sonomicrometry, ultrasonic flow meters, and intraoperative echocardiography. Results are expressed as mean expressed as mean±SEM (ANOVA, paired and unpaired t tests, and χ2 test). There were no significant differences in baseline function (pretransplantation), bypass times, and cardiac ischemic times between the two groups. Posttransplantation sinus rhythm was preserved in all total (P<.0025) and in only one standard transplantation recipient (all required atrial diastole pacing). Significant decreases in RV/LV dV/dt from 113±13 and 123±14 mL/s to 69±6 and 85±10 mL/s after transplantation were measured in the standard group. No significant changes occurred in the total group after transplantation with respect to RV/LV diastolic filling. After transplantation, left atrial contractility and relaxation (-dP/dt) decreased significantly in the standard group by 43% and 70%, respectively, whereas in the total transplantation group, there were no observed changes in left atrial contractility and - dP/dt. A significant increase in the septum to RV free wall dimension in the standard group suggests altered geometry. Conclusions. Total AV transplantation is a feasible alternative to standard cardiac transplantation and conserves both normal sinus rhythm and synchronized heating of the atria and ventricles. Ischemic and bypass times are comparable in patients undergoing either method. These data suggest that RV/LV diastolic function and geometry and atrial systole are better preserved in the total AV transplantation technique.

Duke Scholars

Published In

Circulation

ISSN

0009-7322

Publication Date

November 1, 1996

Volume

94

Issue

9 SUPPL.

Related Subject Headings

  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Bittner, H. B., Chen, E. P., Kendall, S. W., Craig, D., & Van Trigt, P. (1996). Total atrioventricular cardiac transplantation preserves atrial systole and ventricular diastolic filling. Circulation, 94(9 SUPPL.).
Bittner, H. B., E. P. Chen, S. W. Kendall, D. Craig, and P. Van Trigt. “Total atrioventricular cardiac transplantation preserves atrial systole and ventricular diastolic filling.” Circulation 94, no. 9 SUPPL. (November 1, 1996).
Bittner HB, Chen EP, Kendall SW, Craig D, Van Trigt P. Total atrioventricular cardiac transplantation preserves atrial systole and ventricular diastolic filling. Circulation. 1996 Nov 1;94(9 SUPPL.).
Bittner, H. B., et al. “Total atrioventricular cardiac transplantation preserves atrial systole and ventricular diastolic filling.” Circulation, vol. 94, no. 9 SUPPL., Nov. 1996.
Bittner HB, Chen EP, Kendall SW, Craig D, Van Trigt P. Total atrioventricular cardiac transplantation preserves atrial systole and ventricular diastolic filling. Circulation. 1996 Nov 1;94(9 SUPPL.).

Published In

Circulation

ISSN

0009-7322

Publication Date

November 1, 1996

Volume

94

Issue

9 SUPPL.

Related Subject Headings

  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology