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FIGURE 56-20 Heart transplantation after total cavopulmonary connection in a patient with bilateral superior vena cavae. The innominate vein from the donor is used to reconstruct the left superior vena cava. Alternatively (not shown), if the left superior vena cava is too short, a synthetic graft can be used to route the left superior vena cava blood along the coronary sinus of the donor heart into the recipient native inferior vena cava.