Explain Bi-caval Anastomosis Teclznique

This is the currently referred technique. In presuming the donor heart, more of SVC is dissected and retained. The length of IVC retained depends on whether donor liver is used for transplant or not. Left atrium is divided behind inter atrial groove and just in front of right and left pulmonary veins. Aorta and pulmonary arteries are divided and recipient's heart removed. First the two left atria are anastomosed with 3 '0' prolene sutures and ends up anterior to right superior pulmonary vein. In this technique, there is no need for anastomosing atrial septum. Then end-to-end anastomosis of inferior and superior vena cavae are done with prolene sutures. After tailoring pulmonary arterial trunk, anastomosis is done with 4'0' prolene sutures. Finally the aortic anastolnosis is done. De-airing of the cardiac chambers and aortic root are done and aortic clamp removed. Atrial and ventricular pacing wires are placed.