Techniques in orthotopic cardiac transplantation: a review.

Cardiac transplantation currently is the most effective therapy for end-stage heart failure. Since the origination of the standard biatrial technique, alternative methods such as the bicaval and "total" techniques have been devised with the hope of improving postoperative physiologic and clinical parameters. In general, the newer techniques are at least as effective as the original technique with respect to arrhythmia, valvular function, hemodynamics, exercise capacity, and survival, but whether any one technique offers clear benefits over another has been controversial. The bicaval technique is most commonly used today, and the general consensus is that this technique ultimately will demonstrate clinical superiority.