About a decade after the introduction of the bicaval heart transplantation technique a reduction of tricuspid valve incompetence compared to the standard technique by Lower and Shumway is still discussed controversially. A total of 72 patients were transplanted at our institution between 2000 and 2008, and divided into two groups based on their operative techniques. The patients in both groups were followed up as outpatients and were examined with trans-thoracic echocardiography. Patients in both groups were similar in demographic data. Trans-thoracic echocardiography showed a reduction of tricuspid valve regurgitation in follow up, but not with statistical significance. The left atrium was significantly enlarged in the standard group. This study showed acceptable survival rates for both groups. The reduction of tricuspid valve regurgitation in the bicaval group might have important impact on the long term preservation of cardiac function. Total orthotopic heart transplantation with bicaval anastomosis should be preferred for heart transplantation.