Perioperative Management of a Donation After Circulatory Death Heart Transplant in a Recipient With a Persistent Left Superior Vena Cava

A 60-year-old male with end-stage heart failure due to non-ischemic cardiomyopathy and mitral regurgitation presented for a donation after circulatory death (DCD) orthotopic heart transplantation. Intraoperatively, a persistent left superior vena cava (PLSVC), absent innominate vein, and small right superior vena cava were discovered. A bicaval technique was performed, using an interconnecting prosthetic conduit to anastomose the PLSVC with the right atrial appendage and an interposition graft to the native R SVC. After surgery, a transthoracic echocardiogram showed a left ventricular ejection fraction of 60-65% and improved systolic function. The postoperative course was uneventful, with discharge home after 16 days.