Transplant Techniques

Orthotopic heart transplant is when the donor heart replaces the native heart. The alternative is heterotopic transplant (Fig 1) in which the donor heart is placed beside the native heart, which continues to function. The first human heart transplant was performed by Christiaan Barnard in 1967 using the heterotopic technique. This is now seldom used, but may be appropriate in cases of severe recipient pulmonary hypertension, or a significant size mismatch between a small donor and a large recipient [2].

The original orthotopic procedure involved grafting the donor right atrium directly on to the recipient right atrium (Fig 2). The more recent bicaval technique (Fig 3) involves the superior vena cava and inferior vena cava being attached separately [3]. This helps to preserve normal atrial structure and function.