Heart transplantation--surgical results.

Heart transplantation has become a widely used therapeutic option for the treatment of end-stage heart failure. Since the first human orthotopic heart transplant in the late 1960s, the surgical technique has undergone several revisions. These revisions have addressed certain anatomic and geometric distortions that occurred with the original biatrial technique of Lower and Shumway. Early revisions have included the use of a bicaval technique for implanting the right atrium. Subsequently, the additional use of a direct pulmonary venous anastomosis has lead to the surgical concept of the total orthotopic heart transplant. These revisions of the original bi-atrial technique have led to a decrease in atrial size and distortion, conduction abnormalities and tricuspid and mitral valve regurgitation. This has also resulted in less atrial thromboembolic events, less need for permanent postoperative pacemaker placement, and in an overall increase in right and left heart performance in the early postoperative period. Overall, this has contributed to better clinical results with patients returning sooner to their normal exercise capacity. Ninety percent of heart transplant patients lead a relatively normal lifestyle having no limitations in their activity and 40 % return to work. We believe that the technique of total orthotopic heart transplantation has improved surgical results and clinical outcomes.