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Eur J Cardiothorac Surg 2001;19:307-312
© 2001 Elsevier Science NL

Systemic embolism: a serious complication after cardiac transplantation avoidable by bicaval technique

^a Department of Cardiovascular Surgery, Children's Hospital la Timone, Rue de l'Armée d'Afrique, 13385 Marseille, Cedex 5, France
^b Department of Cardiology, La Timone Hospital, Rue de l'Armée d'Afrique, 13385 Marseille, Cedex 5, France
^c Department of Medical Information, La Timone Hospital, Rue de l'Armée d'Afrique, 13385 Marseille, Cedex 5, France

Received 8 September 1999; received in revised form 14 November 2000; accepted 11 December 2000.

Corresponding author. Tel.: +33-491-386676; fax: +33-491-386704
e-mail: alberi{at}free.fr

Objective: Systemic embolism is a serious complication after classical orthotopic transplantation, presumably originating from enlarged left atrium. We specifically studied this problem after classical and modified bicaval transplantation. Methods: Between December 1985 and March 1999 we consecutively performed 72 classical and 106 modified heart transplantation. Modification included bicaval anastomosis and recipient left atrium maximal reduction. Mean age was 47 years. All the patients received an antiplatelet therapy and were routinely followed. When clinical signs of systemic embolism were present, a neurological evaluation and transesophageal echocardiography were done. Sixty matched patients (30 of each group) had comparative transesophageal echocardiography study, at least 6 months after transplantation. Results: Perioperative mortality was 17.4%. Mean follow-up was 6.8 2+/47 years. All patients were in sinus rhythm. Among 147 survivors, 11 patients who underwent classical transplantation had a systemic embolism, 1 month to 12 years after transplantation, 15.3%, (11/72). Two limb ischemia and one mesenteric ischemia (needing surgery), seven strokes (one death, two permanent neurological deficit). There was no systemic embolism in the modified technique group (P=0.013). Left atrial comparative transesophageal echocardiography study showed a larger left atrial surface in classical transplantation. 33±4 cm² versus 20±3 cm² in a modified technique, P=0.01. Spontaneous echo contrast was present in 56% of classical technique group associated with atrial thrombosis in nine patients, there were no atrial thrombosis in modified technique group and spontaneous echocontrast was present in 0.5% (P=<0.001). Conclusion: The occurrence of systemic embolism, left atrial spontaneous echocontrast and thrombosis when using classical technique, and the absence of these complications with the bicaval technique justified the use of this method. Our experience with atrial thrombosis and spontaneous echocontrast rises the question of anticoagulation in classical transplantation.

Key Words: Cardiac transplantation • Atrial • Thrombosis • Systemic embolism

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				M. Schnoor, T. Schafer, D. Luhmann, and H. H. Sievers Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1322 - 1331. [Abstract] [Full Text] [PDF]