A lost art-The biatrial technique for adult orthotopic heart transplantation.

OBJECTIVES: The biatrial anastomosis technique was the original method of performing orthotopic heart transplantation. More recently, bicaval implant has become the preferred technique of choice. However, situations such as a complex redo sternotomy or size mismatch between donor and recipient vena cava may necessitate the use of the biatrial technique. METHODS: This article highlights our institutional biatrial implant technique to ensure modern heart transplant surgeons retain proficiency in this method of heart transplantation. RESULTS: Although the pacemaker rates in the biatrial cohort were greater than that in our bicaval cohort, the rates of tricuspid regurgitation and right ventricular dysfunction were similar. CONCLUSIONS: Our manuscript highlights the timing of a biatrial heart transplant and details the operative steps necessary to avoid significant atrial or valvular distortion.