Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Results of the Superior Vena Cava Intimal Layer-Only Suture Technique in Heart Transplantation

  • Sang-Uk Park (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine) ;
  • Kyungsub Song (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine) ;
  • Yun Seok Kim (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine) ;
  • In Cheol Kim (Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine) ;
  • Jae-Bum Kim (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine) ;
  • Namhee Park (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine) ;
  • Woo Sung Jang (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine)
  • Received : 2023.03.09
  • Accepted : 2023.06.10
  • Published : 2023.09.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Superior vena cava (SVC) stenosis during follow-up is a major concern after heart transplantation, and many technical modifications have been introduced. We analyzed the surgical results of the SVC intima layer-only suture technique in heart transplantation. Methods: We performed SVC anastomosis with sutures placed only in the intima during heart transplantation. We measured the area of the SVC at 3 different points (above the anastomosis, at the anastomosis, and below the anastomosis) in an axial view by freely drawing regions of interest, and then evaluated the degree of stenosis. Patients who underwent cardiac computed tomography (CT) at 2 years postoperatively between June 2017 and May 2020 were included in this study. Results: We performed heart transplantation in 41 patients. Among them, 24 patients (16 males and 8 females) underwent follow-up cardiac CT at 2 years postoperatively. The mean age at operation was 49.4±4.9 years. The diagnoses at time of operation were dilated cardiomyopathy (n=12), ischemic heart disease (n=8), valvular heart disease (n=2), hypertrophic cardiomyopathy (n=1), and congenital heart disease (n=1). No cases of postoperative bleeding requiring intervention occurred. The mean CT follow-up duration was 1.9±0.7 years. At follow-up, the mean areas at the 3 key points were 2.7±0.8 cm2, 2.7±0.8 cm2, and 2.7±1.0 cm2 (p=0.996). There were no SVC stenosis-related symptoms during follow-up. Conclusion: The suture technique using only the SVC intimal layer is a safe and effective method for use in heart transplantation.

Keywords

References

  1. Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 2006;85:37-42. https://doi.org/10.1097/01.md.0000198474.99876.f0
  2. Parish JM, Marschke RF Jr, Dines DE, Lee RE. Etiologic considerations in superior vena cava syndrome. Mayo Clin Proc 1981;56:407-13.
  3. Doring V, Marcsek P. Atrial flap anastomosis: an alternative technique for orthotopic heart transplantation. Ann Thorac Surg 1998;65:1163-4. https://doi.org/10.1016/s0003-4975(98)00036-8
  4. Kim HR, Jung SH, Kim JJ, Yang DH, Yun TJ, Lee JW. Modified bicaval technique in orthotopic heart transplantation: comparison with conventional bicaval technique. Circ J 2018;83:117-21. https://doi.org/10.1253/circj.CJ-18-0567
  5. Tadros HJ, Whelihan JT, Lopez-Colon D, et al. Risk factors associated with post-transplant superior caval vein stenosis in paediatric heart transplantation. Cardiol Young 2021;31:1589-94. https://doi.org/10.1017/S1047951121000573
  6. el Gamel A, Yonan NA, Grant S, et al. Orthotopic cardiac transplantation: a comparison of standard and bicaval Wythenshawe techniques. J Thorac Cardiovasc Surg 1995;109:721-30. https://doi.org/10.1016/S0022-5223(95)70354-3
  7. Deleuze PH, Benvenuti C, Mazzucotelli JP, et al. Orthotopic cardiac transplantation with direct caval anastomosis: is it the optimal procedure? J Thorac Cardiovasc Surg 1995;109:731-7. https://doi.org/10.1016/S0022-5223(95)70355-1
  8. Weiss ES, Nwakanma LU, Russell SB, Conte JV, Shah AS. Outcomes in bicaval versus biatrial techniques in heart transplantation: an analysis of the UNOS database. J Heart Lung Transplant 2008;27:178-83. https://doi.org/10.1016/j.healun.2007.11.003
  9. Sze DY, Robbins RC, Semba CP, Razavi MK, Dake MD. Superior vena cava syndrome after heart transplantation: percutaneous treatment of a complication of bicaval anastomoses. J Thorac Cardiovasc Surg 1998;116:253-61. https://doi.org/10.1016/s0022-5223(98)70124-2
  10. Pedrazzini GB, Mohacsi P, Meyer BJ, Carrel T, Meier B. Percutaneous transvenous angioplasty of a stenosed bicaval anastomosis after orthotopic cardiac transplantation. J Thorac Cardiovasc Surg 1996;112:1667-9. https://doi.org/10.1016/S0022-5223(96)70027-2
  11. Sachdeva R, Seib PM, Burns SA, Fontenot EE, Frazier EA. Stenting for superior vena cava obstruction in pediatric heart transplant recipients. Catheter Cardiovasc Interv 2007;70:888-92. https://doi.org/10.1002/ccd.21296
  12. Aldoss O, Arain NI, Vinocur JM, et al. Frequency of superior vena cava obstruction in pediatric heart transplant recipients and its relation to previous superior cavopulmonary anastomosis. Am J Cardiol 2013;112:286-91. https://doi.org/10.1016/j.amjcard.2013.03.029
  13. Shah M, Anderson AS, Jayakar D, Jeevanandam V, Feldman T. Balloon-expandable stent placement for superior vena cava-right atrial stenosis after heart transplantation. J Heart Lung Transplant 2000;19:705-9. https://doi.org/10.1016/s1053-2498(00)00121-2
  14. Kitamura S, Nakatani T, Kato T, et al. Hemodynamic and echocardiographic evaluation of orthotopic heart transplantation with the modified bicaval anastomosis technique. Circ J 2009;73:1235-9. https://doi.org/10.1253/circj.cj-08-1098
  15. Kakuta T, Fukushima S, Shimahara Y, et al. Benefits of the modified bicaval anastomosis technique for orthotopic heart transplantation from a size-mismatched marginal donor. Circ J 2019;84:61-8. https://doi.org/10.1253/circj.CJ-19-0441
  16. Salavitabar A, Flyer JN, Torres AJ, et al. Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: a single-center experience assessing risk factors and outcomes. Pediatr Transplant 2018;22:e13267. https://doi.org/10.1111/petr.13267