OBJECTIVE: To present a number of modifications to the conventional heart implant technique in orthotopic cardiac transplants. METHODS: The proposed modifications consist basically of the following: 1) resecting as much of the disease heart as possible during the cardiectomy, leaving only sufficient tissue to enable the new heart to be sutured during the implant; 2) opening the right atrium of the donor heart from the inferior vena cava, close and parallel to the interatrial septum as far as the highest part, where the incision should be sharply directed towards the right atrial apendix; 3) initiating the implant through the pulmonary artery, and 4) suturing the atria simultaneously, in a single plane, atthe level of the septum. These technical modifications have been utilized in all patients undergoing transplants in the three Institutions. REMARKS: The technical changes present the following advantages: 1) a perfect alignment of the pulmonary artery, thereby avoiding bending and torsion and 2) smaller atrial cavities with no sutures protouding into the atria and, consequently, less likelihood of tromboembolic phenomenon or asynchronous contractions of the atria (donor-receiver) which, in addition to facilitating the formation of thrombi, may impair the functioning of the atrioventricular valves. CONCLUSIONS: The method is easily reproducible and can be recommended for orthotopic heart transplants.
heart transplantation; orthotopic