Standard orthotopic heart transplantation

The very first clinical transplants used a technique, with anastomoses of atrium to atrium, which had been developed to allow successful canine experiments (1). A small modification by Barnard led the suture line away from the sino-atrial node. Many years later Sievers (2) described the intact right atrium, with separate caval anastomoses, now the standard procedure, with a proven decrease in need for permanent pacemakers. A further refinement, with intact left atrium and separate pulmonary venous cuff anastomoses (3), the “total orthotopic transplant" has not proven popular.