Impaired exercise parameters in pediatric heart transplant recipients: Comparison of biatrial and bicaval techniques Pahl E, Sundararaghavan S, Strasburger JF, Mitchell BM, Rodgers S, Crowley D, Gidding SS. Impaired exercise parameters in pediatric heart transplant recipients: Comparison of biatrial and bicaval techniques. Pediatr Transplantation 2000: 4: 268±272. # Munksgaard, 2000 Abstract: The exercise performance of pediatric heart transplant recipients and the effects of bicaval anastomosis were studied in 19 children using a Bruce protocol. Although all children had decreased exercise capacity and heart rates when compared with normals, the bicaval anastomosis patients had similar endurance and peak heart rates as the standard biatrial group. Elfriede Pahl 1 , Sreekanthan Sundararaghavan 1 , Janette F. Strasburger 1 , Brett M. Mitchell 1 , Sherrie Rodgers 1 , Dennis Crowley 2 and Samuel S. Gidding 1 1 Departments of Pediatrics and Medicine, Northwestern University Medical School, Chicago, Illinois, USA, 2 Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA Key words: pediatric heart transplantation ± treadmill exercise testing ± biatrial anastomosis ± bicaval anastomosis. Elfriede Pahl MD, 2300 Children's Plaza, Box #21, Chicago, IL 60614, USA Tel.:+1 773-880-4553 Fax:+1 773-880-8111 E-mail: epahl@nwu.edu Accepted for publication 5 January 2000 Although there have been many studies of adult transplant recipients assessing exercise capacity (1±4), there are only a few studies in pediatric heart transplant recipients (5, 6). Hsu et al. have shown that transplant recipients have decreased exercise capacity on a bicycle ergometer protocol (5). However, there are no published studies using an exercise treadmill protocol in pediatric patients. This study characterized the exercise response of children who have undergone cardiac transplantation, using a treadmill protocol. In addition, the impact of the type of surgical anasto- mosis on exercise performance was analyzed. Patients and methods Study group Exercise tests carried out on pediatric heart transplant recipients between 1988 and 1996 at two centers were included in this study, provided that patients met the following criteria: (i)i6 yrs of age; (ii)i1 month post rejection episode; (iii) normal left ventricular function on a recent echocardiogram; and (iv) no evidence of trans- plant coronary artery disease by angiography. The ®rst exercise test following transplantation was used for analysis. There were 19 patients from two centers (16 males and 3 females), as described in Table 1. Two cohorts were identi®ed based on surgical technique. Bicaval anastomosis was performed in ®ve recipients using a pre- viously reported technique (7) and the remainder had standard biatrial technique. Medical records were reviewed to obtain demographics and medications, to exclude recent rejection, and to determine hemodynamics, resting cardiac index Presented in part at The American Heart Association 71st Scienti®c Sessions, Dallas, Texas, November 1998. Abbreviations: b.p.m., beats per minute; DBP, diastolic blood pressure; ECG, electrocardiogram; LVEDP, left ventricular end- diastolic pressure; RA, right atrium; RQ, respiratory quotient; RV, right ventricle; SBP, systolic blood pressure; VO2, oxygen consumption. Pediatr Transplantation 2000: 4: 268±272 Printed in UK. All rights reserved Copyright # Munksgaard 2000 Pediatric Transplantation ISSN 1397±3142 268