TY - JOUR
T1 - Biatrial Versus Bicaval Orthotopic Heart Transplantation
T2 - A Systematic Review and Meta-Analysis
AU - Zijderhand, Casper F
AU - Veen, Kevin M
AU - Caliskan, Kadir
AU - Schoonen, Tamar
AU - Mokhles, M Mostafa
AU - Bekkers, Jos A
AU - Manintveld, Olivier C
AU - Constantinescu, Alina A
AU - Brugts, Jasper J
AU - Bogers, Ad J J C
AU - Takkenberg, Johanna J M
N1 - Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/8
Y1 - 2020/8
N2 - BACKGROUND: Orthotopic heart transplantation (OHT) is the gold standard treatment in end-stage heart disease. Controversy remains whether bicaval OHT is superior to biatrial OHT in both early and late outcomes. This study aimed to provide an overview of the early and late outcomes in patients who underwent a bicaval or biatrial OHT.METHODS: A systematic literature search was performed for articles published before December 2017. Studies comparing adult patients undergoing biatrial OHT and bicaval OHT were included. Early outcomes were pooled in odds ratios and late outcomes were pooled in rate ratios. Late survival was visualized by a pooled Kaplan-Meier curve.RESULTS: A total of 36 publications were included in the meta-analysis, counting 3555 patients undergoing biatrial OHT and 3208 patients undergoing bicaval OHT. Early outcomes in mortality, tricuspid regurgitation, mitral regurgitation, and permanent pacemaker implantation differed significantly in favor of the bicaval OHT patients. Long-term survival was significantly better in patients undergoing bicaval vs biatrial OHT (hazard ratio, 1.32; 95% confidence interval, 1.1-1.6; P = .008). Also, late tricuspid regurgitation was less frequently seen in the bicaval OHT patients (rate ratio, 2.14; 95% CI, 1.17-3.94; P = .014).CONCLUSIONS: This systematic review with meta-analysis shows that bicaval OHT results in more favorable early and late outcomes for patients undergoing a bicaval OHT compared with a biatrial OHT. Therefore, bicaval OHT should be considered as preferable technique for OHT.
AB - BACKGROUND: Orthotopic heart transplantation (OHT) is the gold standard treatment in end-stage heart disease. Controversy remains whether bicaval OHT is superior to biatrial OHT in both early and late outcomes. This study aimed to provide an overview of the early and late outcomes in patients who underwent a bicaval or biatrial OHT.METHODS: A systematic literature search was performed for articles published before December 2017. Studies comparing adult patients undergoing biatrial OHT and bicaval OHT were included. Early outcomes were pooled in odds ratios and late outcomes were pooled in rate ratios. Late survival was visualized by a pooled Kaplan-Meier curve.RESULTS: A total of 36 publications were included in the meta-analysis, counting 3555 patients undergoing biatrial OHT and 3208 patients undergoing bicaval OHT. Early outcomes in mortality, tricuspid regurgitation, mitral regurgitation, and permanent pacemaker implantation differed significantly in favor of the bicaval OHT patients. Long-term survival was significantly better in patients undergoing bicaval vs biatrial OHT (hazard ratio, 1.32; 95% confidence interval, 1.1-1.6; P = .008). Also, late tricuspid regurgitation was less frequently seen in the bicaval OHT patients (rate ratio, 2.14; 95% CI, 1.17-3.94; P = .014).CONCLUSIONS: This systematic review with meta-analysis shows that bicaval OHT results in more favorable early and late outcomes for patients undergoing a bicaval OHT compared with a biatrial OHT. Therefore, bicaval OHT should be considered as preferable technique for OHT.
KW - Global Health
KW - Heart Failure/mortality
KW - Heart Transplantation/methods
KW - Humans
KW - Survival Rate/trends
U2 - 10.1016/j.athoracsur.2019.12.048
DO - 10.1016/j.athoracsur.2019.12.048
M3 - Article
C2 - 32035050
SN - 0003-4975
VL - 110
SP - 684
EP - 691
JO - The Annals of Thoracic Surgery
JF - The Annals of Thoracic Surgery
IS - 2
ER -