Caval reconstruction techniques in orthotopic liver transplantation

Table 7 Comparing standard, piggyback and side-to-side cavocaval anastomosis

Ref.	Anastomosis	Conclusion
Lerut et al[16]	Conventional with routine VVB, piggyback with selective VVB, STSCCA	Piggyback and STSCCA groups had reduced warm ischemia time (P < 0.001), reduced need for intraoperative blood products (P < 0.01), lower rates of reoperation for bleeding (P < 0.01). STSCCA had higher frequency of immediate extubation (P < 0.001). STSCCA preserves advantages of piggyback technique including reduced implantation time and need for blood products while also eliminating VVB and reducing ventilation time
Navarro et al[48]	Piggyback, STSCCA, ETSCCA	Reduced vascular complication in STSCCA compared to piggyback group with less cases of Budd Chiari syndrome and fewer releases of the cavocaval running suture (no P-value reported)
Hesse et al[15]	Conventional with selective VVB, piggyback with selective VVB, STSCCA	Use of packed red blood cells higher in piggyback group than standard group (P = 0.01). Use of packed red blood cells (P = 0.01), number of patients operated on for hemorrhage (0.002) and use of VVB (P = 0.02) lower in STSCCA than other two groups. Perioperative FFP, time in ICU, postoperative graft function and survival similar between the three groups (P = NS, values not reported)
Lai et al[49]	Conventional with VVB, piggyback, STSCCA	STSCCA group with lowest median cold (P = 0.001) and warm ischemia times (P < 0.0001), best immediate postoperative graft function (P < 0.0001), lowest transaminase peak (P = 0.007) and best bile output (P = 0.003). No complications reported
González et al[50]	Conventional with VVB, conventional without VVB, IVC preservation	Total operating time (P = 0.004), packed red blood cell (P = 0.009), fresh frozen plasma (P = 0.005) transfusion lower in the IVC preservation group. Postoperative kidney and renal function did not differ between groups. Incidence of complications similar between groups

STSCCA: Side-to-side cavocaval anastomosis; ETSCCA: End-to-side cavocavostomy; IVC: Inferior vena cava; VVB: Venovenous bypass; ICU: Intensive care unit; NS: Non-significant.