During almost 30 years the Lower and Shumway's technique for orthotopic heart transpantation has been performed with very good results. Complications like venous stasis, thrombus formation, atrial arrhythmias and also tricuspid and mitral regurgitation have been found in the late postoperative period. In 1995 we started to use the bicaval technique in all cases (6 patients). Five patients were male and the mean age was 50,6. Dilated and ischemic myocardiopathy was present in two cases in each group; Chagas' disease and rheumatic disease in others. Three patients had undergone prior surgeries; in one case three consecutive aortic valve replacement; in other one a definitive pacemaker implantation; and the last one had 2 myocardial revascularizations. The surgical technique in most cases consisted of the anastomoses of all the pulmonary veins with the left atrium of the donor followed by anastomoses of the superior and inferior vena cava, pulmonary artery and aorta. All donors were procured in city hospitals, and underwent multiple organ harvesting. There were no immediate postoperative deaths ; and at follow-up varying from 1 to 15 months all patients are alive. No significant differences in the both groups were observed for the anoxic time, extracorporeal circulation time, implantation time, atrial tachyarrhythmias, bleeding and the hospital discharge time. A significant difference was observed (p<0,05) for the temporary pacemaker utilized and for the tricuspid valve regurgitation. We believe that the bicaval technique besides reducing the atrial cavity, is a simple technique, with low complications and might be used more frequently.
Heart transplantation; Cardiomyopathy; Chagas' cardiomyopathy
