Orthotopic Heart Transplantation (HTx) implantation methods have developed over time. The use of novel, modified bicaval strategies to reduce warm ischemia has recently become more common in the literature. In our department, HTx was performed on n=238 patients between 2010 and 2022. After looking back, the receivers were separated according to how their anastomoses were made. After releasing the aortic cross-clamp during the reperfusion, anastomoses were sutured either in a biatrial (n=37), bicaval (n=191), or modified bicaval (n=10) way with suturing of the superior cava vein. Biatrial warm ischemia lasted 52min, bicaval warm ischemia lasted 60min, while the modified bicaval approach only lasted 48min (p 0.001). Biatrial (27.0%) and bicaval (28.8%) anastomoses had similar rates of severe Primary Graft Dysfunction (PGD). When using the modified bicaval method, only one patient (10.0%) experienced PGD. Biatrial had a postoperative pacemaker implantation rate of 18.2% compared to bicaval's 3.0% and modified bicaval's(p=0.01). Compared to both biatrial and standard bicaval approaches, the modified bicaval technique allows for a reduction in the critical warm ischemia during HTx. Therefore, bicaval anastomoses are highly advised, ideally in a modified fashion.
