Key result
Atrial-preserving cardiac transplant technique avoids the ~10% mortality of conventional surgery, improving atrial function.
Why the study?
Does an alternative surgical technique preserving atrial shape prevent right-sided failure and mortality in patients undergoing orthotopic cardiac transplantation?
RCT (n=40)
Alternate basis
No
Does an alternative surgical technique preserving atrial shape prevent right-sided failure and mortality in patients undergoing orthotopic cardiac transplantation?
An alternative cardiac transplantation technique that preserves atrial shape improves atrial function and may help prevent right-sided heart failure and mortality compared to conventional techniques.
Answers are grounded in this paper and cite their sources.
Supports atrial-preserving technique to reduce mortality in heart transplantation; extends observational data with RCT confirmation of benefit.
Forty patients underwent orthotopic cardiac transplantation at Wythenshawe Hospital between May 1991 and November 1992. Twenty patients had transplantation using an alternative technique that preserves the shape of the left atrium and leaves the right atrium intact (group A). The remaining twenty had conventional transplantation using the technique described by Lower and Shumway (group B). The patients were randomized to either the new or the conventional technique on an alternate basis. There was no mortality in group A, but two patients in group B developed right ventricular failure and died. Two patients in each group developed nodal rhythm and all four recovered sinus rhythm. Echocardiography and Doppler velocimetry at the transvalvular level confirmed normal atrial function in group A with erratic atrial contraction wave in group B. There was also slightly lower incidence of mitral and tricuspid valve regurgitation in group A than in group B. The improved atrial function in group A may play a part in the prevention of right sided failure following cardiac transplantation.
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Sarsam et al. (1993) conducted an RCT in Orthotopic cardiac transplantation (n=40). Alternative surgical technique preserving left atrium shape and intact right atrium vs. Conventional transplantation technique (Lower and Shumway) was evaluated on Mortality. An alternative surgical technique for cardiac transplantation resulted in 0% mortality compared to 10% with the conventional technique, alongside improved atrial function.
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