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J Thorac Cardiovasc Surg 2007;134:1322-1331
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Bicaval versus standard technique in orthotopic heart transplantation: A systematic review and meta-analysis

^a Institute of Social Medicine, Medical University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
^b Department of Cardiovascular Surgery, Medical University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.

^_* Address for reprints: Maike Schnoor, Institute of Social Medicine, Medical University of Schleswig-Holstein, Campus Lübeck, Beckergrube 43-47, 23552 Lübeck, Germany. (Email: Maike.schnoor{at}uk-sh.de).

Objective: We aimed to evaluate and compare the efficacy of the bicaval and the biatrial standard techniques in orthotopic heart transplantation.

Methods: A systematic review with meta-analysis was performed. As data sources, we used the electronic databases EMBASE and Medline (1966–August 2006), hand searching in 4 journals, expert consultation, and reference lists of reviews. Observational and randomized and prospective and retrospective controlled trials that reported outcomes on the 2 techniques of heart transplantation were considered.

Results: A total of 23 retrospective and 18 prospective studies were included. Meta-analyses of prospective trials including between 228 and 472 patients revealed significant superiority of the bicaval technique in comparison with the biatrial procedure for early atrial pressure (weighted mean difference, –3.95; 95% confidence interval, –6.50 to –1.40), perioperative mortality (odds ratio, 0.41; 95% confidence interval, 0.17 to 0.98), tricuspid valve regurgitation (odds ratio, 0.23; 95% confidence interval, 0.15 to 0.36), and sinus rhythm (odds ratio, 7.01; 95% confidence interval, 2.57 to 19.13). The latter also showed a significant difference in the analysis of retrospective studies (odds ratio, 2.69; 95% confidence interval, 1.55 to 4.66).

Conclusion: In summary, this systematic review and meta-analysis provides evidence of clinically relevant beneficial effects of the bicaval technique in comparison with those of the standard technique. Nevertheless, the longer-term beneficial effects of the bicaval technique remain to be evaluated.

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