Bicaval vs biatrial anastomosis techniques in orthotopic heart transplantation: An updated analysis of the UNOS database

Jennifer Maning, Vanessa Blumer, Gabriel Hernandez, Edgar Acuna, Hua Li, Sandra V. Chaparro

Research output: Contribution to journalArticlepeer-review


Background: Despite the significant increase in the number of orthotopic heart transplants (OHT) performed yearly using the bicaval anastomosis technique, the impact on long-term outcomes remains a topic of debate. We analyzed the United Network for Organ Sharing (UNOS) database in search of the latest insight. Methods: We performed a retrospective analysis of the UNOS database from 2006 to 2016 to identify first-time OHT recipients. Patients were primarily stratified according to anastomosis technique: bicaval vs biatrial. Baseline characteristics and clinical status were recorded. The primary endpoint was all-cause mortality. Secondary outcomes included need for permanent pacemaker (PPM), and length of hospital stay (LOS). The Kaplan-Meier method was used to compare survival between the two groups. The Cox proportional hazards regression model was used to conduct multivariable analysis. Statistical significance established at P <.0001. Results: A total of 26 990 patients were identified. Of those who met the inclusion criteria (21 597), 16 573 (77%) underwent bicaval anastomosis. There were no major differences in baseline characteristics between the two groups. The bicaval anastomosis technique was not associated with increased survival during the study period (hazard ratio: 0.97; P =.3557), but the bicaval group required postoperative PPM less often (2.51% vs 5.79%, P <.0001) and was associated with shorter LOS on multivariable analysis. Conclusions: The use of either bicaval or biatrial anastomosis during OHT offers comparable survival advantage. Nonetheless, bicaval anastomosis is associated with less need for postoperative PPM and slightly shorter LOS.

Original languageEnglish (US)
Pages (from-to)2242-2247
Number of pages6
JournalJournal of cardiac surgery
Issue number9
StatePublished - Sep 1 2020
Externally publishedYes


  • bicaval anastomosis
  • outcomes
  • transplant

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Bicaval vs biatrial anastomosis techniques in orthotopic heart transplantation: An updated analysis of the UNOS database'. Together they form a unique fingerprint.

Cite this