Technique for commissural alignment of the arterial trunks during orthotopic heart transplantation

Twisting, buckling, and stretching of the pulmonary artery due to faulty alignment or disproportionately long arterial trunks are known technical complications during orthotopic heart transplantation. Failure to recognize these potentially lethal problems intraoperatively may lead to acute ventricular distention and failure. We describe a technique for alignment of the arterial trunks during orthotopic heart transplantation based on the constant commissural orientation of the aortic and pulmonary valves.