Right ventricle-sparing heart transplant: promising new technique for recipients with pulmonary hypertension John A Elefteriades, MD, Costantinos J Lovoulos,

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Right ventricle-sparing heart transplant: promising new technique for recipients with pulmonary hypertension John A Elefteriades, MD, Costantinos J Lovoulos, MD, George Tellides, MD, PhD, Lee J Goldstein, BS, Edward J Rocco, Spyros G Condos, PhD, Gary S Kopf, MD The Annals of Thoracic Surgery Volume 69, Issue 6, Pages 1858-1863 (June 2000) DOI: 10.1016/S0003-4975(00)01318-7

Fig 1 Excision of the recipient left ventricle. See text. The Annals of Thoracic Surgery 2000 69, 1858-1863DOI: (10.1016/S0003-4975(00)01318-7)

Fig 2 Isolation of coronary blood supply. The right ventricular-sparing transplant preserves the right coronary artery and the posterior descending coronary artery, and the left main coronary artery and the left anterior descending, thus maintaining direct perfusion of the right ventricle through the acute marginal branches of the right coronary artery, the posterior descending coronary artery and its septals, and the left anterior descending and its septals. The Annals of Thoracic Surgery 2000 69, 1858-1863DOI: (10.1016/S0003-4975(00)01318-7)

Fig 3 Cut edge after removal of the left ventricle. A continuous suture achieves hemostasis of the cut ventricular edge. The aortic valve has been oversewn to prevent regurgitation into the pericardial space. The Annals of Thoracic Surgery 2000 69, 1858-1863DOI: (10.1016/S0003-4975(00)01318-7)

Fig 4 Left atrial anastomosis. The posterior mitral annulus has been excised, providing entry to the recipient left atrium (LA). This incision is continued toward the left atrial appendage. The donor left atrial opening is anastomosed to the left atrial free wall posteriorly and to the mitral valve annulus and anterior leaflet anteriorly. The annulus and leaflet from a strong fibrous ring for suture placement. (LV = left ventricular; RA = right atrium; SVC = superior vena cava.) The Annals of Thoracic Surgery 2000 69, 1858-1863DOI: (10.1016/S0003-4975(00)01318-7)

Fig 5 Completed right ventricular-sparing heart transplant. The entire donor heart fits nearly orthotopically in the space left behind by excision of the left ventricle (LV). Space should be even more ample in the clinical setting of advanced left ventricular dilatation. (Ao = aorta; PA = pulmonary artery; LA = left atrium; RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2000 69, 1858-1863DOI: (10.1016/S0003-4975(00)01318-7)

Fig 6 Schematic diagram of connections and flow patterns in right ventricular-sparing heart transplantation. (Ao = aorta; PA = pulmonary artery; LA = left atrium; LV = right ventricle; RA = right atrium; RV = right ventricle; D = donor; R = recipient.) The Annals of Thoracic Surgery 2000 69, 1858-1863DOI: (10.1016/S0003-4975(00)01318-7)