William C. Frankel, Bogdan A. Kindzelski, Benjamin Yang, Rashed Mahboubi, Miza Salim Hammoud, Andrew J. Toth, Hani K. Najm, Gösta B. Pettersson, Tara Karamlou
Cleveland Clinic. Corewell East William Beaumont University Hospital.
United States
Journal of Thoracic and Cardiovascular Surgery Open
JTCVS Open 2025; 23: 225-234
DOI: 10.1016/j.xjon.2024.10.023
Abstract
Objective: In an effort to overcome limitations of conventional techniques for surgical repair of partial anomalous pulmonary venous connection (PAPVC), we developed the lateral caval flap (LCF) technique, which leverages a native endocardial surface to create unobstructed recruitment of the anomalous pulmonary veins to the left atrium. In this study, we report the long-term outcomes of the LCF and conventional techniques for repair of right-sided PAPVC.
Methods: In total, 109 adult patients (mean age 48 years; 57% male) who underwent right-sided PAPVC repair (53 LCF, 34 single-patch, 13 double-patch, 7 pericardial roll, and 2 Warden procedure) from 1997 to 2022 were retrospectively reviewed. Outcomes included operative mortality, major morbidity, arrythmias, systemic and pulmonary venous pathway obstruction, survival, and reintervention.
Results: Operative mortality was 1% and there were no in-hospital deaths after LCF repair; 4 patients had strokes (4%) including 2 nondisabling strokes after LCF repair (4%), 19 patients developed new postoperative atrial fibrillation/flutter (24%) including 9 after LCF repair (24%), and 27 patients developed new early sinus node dysfunction (26%) including 13 after LCF repair (26%). Although sinus-node dysfunction was transient in most patients, 7 required permanent pacemaker implantation (7%). Survival at 1, 5, 10, and 15 years was 95%, 89%, 86%, and 81%, respectively. At a median follow-up of 6 years, 9 patients developed systemic or pulmonary venous pathway obstruction. Freedom from cardiac reintervention at 5 years was 89% overall and 98% after LCF repair.
Conclusions: All of the described techniques for repair of right-sided PAPVC yielded acceptable short- and long-term outcomes. LCF is a valid technique for right-sided PAPVC repair with a low risk of venous pathway obstruction compared with conventional techniques. Sinus node dysfunction and atrial tachyarrhythmias remain challenges.
Category
Segmental Pulmonary Venous Disease. Without a Focus on Pulmonary Hypertension
Age Focus: Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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