Application of modified bicaval technique for pediatric heart transplant with oversized donor heart
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CASE REPORT
Application of modified bicaval technique for pediatric heart transplant with oversized donor heart Takaya Hoashi1 · Heima Sakaguchi2 · Masatoshi Shimada1 · Kenta Imai1 · Motoki Komori1 · Hajime Ichikawa1 Received: 16 July 2019 / Accepted: 29 November 2019 © The Japanese Association for Thoracic Surgery 2019
Abstract Whereas bicaval technique is an effective surgical method, standard bicaval technique for younger age and donor/recipi‑ ent caval mismatch was reported to have a risk of superior vena caval obstruction. Between 2016 and 2019, three patients with dilated cardiomyopathy aged 10 years or younger underwent orthotropic heart transplantation with modified bicaval technique at our institute. Donor/recipient body weight and height ratios were 2.36, 0.77, and 2.61 and 1.37, 0.94, and 1.51, respectively. All patients were preoperatively supported by a left ventricular assist device: Excor Pediatric in two patients and Jarvik 2000 in one. Duration of LVAD support was 180, 238, and 220 days. One patient required revision of pulmonary anastomosis during the operation; accordingly, the chest was closed 3 days later. There was no mortality. Caval obstructions were not observed. Three months after the operation, tricuspid regurgitation was mild in two patients and trivial in one. Keywords Pediatric heart transplantation · Modified bicaval technique
Introduction
Cases
Whereas bicaval technique is effective to avoid atrioven‑ tricular valve insufficiency, rhythm disturbances, thrombus formation, and septal aneurysm [1, 2], standard bicaval tech‑ nique for younger age at transplantation and donor/recipient caval mismatch was reported to have a risk of SVC obstruc‑ tion at pediatric orthotopic heart transplantation [3]. The modified bicaval technique is a useful means of avoiding shrinkage, retraction, and distortion of the venae cavae [4, 5]. This suggests that it can be applied for pediatric ortho‑ topic heart transplantations, even if a significant mismatch in donor/recipient weight is associated. Our institution has applied this technique for all heart recipients aged 10 years or younger. Here, we report our experiences confirming the utility of the modified bicaval technique for heart transplant recipients with small body size.
Patients
* Takaya Hoashi [email protected]‑u.ac.jp 1
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5‑7‑1, Fujishiro‑dai, Suita, Osaka 565‑8565, Japan
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
2
From 2016 to 2019, three patients with dilated cardiomyo‑ pathy aged 10 years or younger underwent orthotropic heart transplantation at our institute (Table 1). Donor/recipient body weight ratios were 2.36, 0.77, and 2.61 and donor/ recipient height ratios were 1.37, 0.94, and 1.51, respec‑ tively. All patients were supported by a left ventricular assist device (LVAD): Excor Pediatric in two patients and Jarvik 2000 in one. The duration of LVAD support was 180,
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