Minimally invasive versus sternotomy approach for double‐patch repair of partial anomalous pulmonary venous connection and sinus venosus defect in pediatric and adult patients: Mid to long‐term outcomes

Abstract

Background Several surgical techniques have been proposed to repair right partial anomalous pulmonary venous connection (PAPVC) along with sinus venosus defect (SVD). This study aimed to compare the perioperative data and outcomes of double‐patch repair using a minimally invasive approach versus conventional sternotomy in pediatric and adult patients. Methods This retrospective study was conducted on 48 minimally invasive cases and 35 sternotomy cases, undergoing surgery by a single surgeon between July 2002 and August 2020. For all patients, repair was performed using the double‐patch technique. In the minimally invasive approach, right mini‐thoracotomy was performed with central cannulation for children and with peripheral cannulation for adults. The patients were classified into two pediatric and adult groups, and each group was categorized into minimally invasive and sternotomy approaches. They were followed‐up by transthoracic echocardiography and electrocardiography before and early after surgery, 3 and 6 months after surgery, and then annually. The relative data were compared between the two approaches in terms of perioperative findings, postoperative pulmonary vein or superior vena cava (SVC) stenosis, and sinus node dysfunction. Results This study included 25 minimally invasive cases and 19 sternotomy cases in the pediatric group (mean age, 4.99 ± 4.28 and 6.10 ± 4.39 years, respectively) and 23 minimally invasive cases and 16 sternotomy cases in the adult group (mean age, 35.73 ± 8.06 and 32.62 ± 9.80 years, respectively). The mean and median follow‐ups were 6.31 ± 4.92 years and 6 years (range: 6 month−18 year) in the pediatric group and 6.15 ± 4.53 years and 5 years (range: 6 month−18 year) in the adult group, respectively. The mean chest tube drainage was significantly lower in the minimally invasive pediatric group (p = .03), and the mean blood transfusion volume was significantly lower in the minimally invasive adult group compared to the other groups (p = .03). No stenosis occurred in the pulmonary veins. Mild SVC stenosis occurred in one patient in the minimally invasive pediatric group, with no need for reintervention. All patients had a normal sinus rhythm, except for the mentioned case with a transient, first‐degree atrioventricular block, which spontaneously reverted to the normal sinus rhythm. Conclusions The minimally invasive approach can be a safe and practical alternative for the double‐patch repair of PAPVC and SVD. It ensures a repair with comparable quality to sternotomy, but with better cosmetic and psychological outcomes.

Repair of Scimitar Syndrome with Intact Atrial Septum in a Two-Year-Old Child Via Vertical Right Axillary Thoracotomy

“…We have previously reported our outcomes for repair of a wide variety of heart defects in infants and children using the VRAT approach. Others [5] have demonstrated the superiority of this approach as well which expands beyond the cosmetic aspect to the shorter length of hospital stay and quicker return to full activity [6]. More data will be needed prior to considering this approach as a new standard in such cases.…”

Minimal-Access Atrial Septal Defect (ASD) Closure

“…In single-centre retrospective reviews for secundum ASD As outlined within the guidelines for ASD management, surgical closure is becoming increasingly relevant, compared to transcatheter device closures, for more-complex atrial septal lesions. Clinical case series comparing minimal-access approaches with median sternotomy for adult and paediatric patients with sinus venosus defects and partial anomalous pulmonary venous drainage [34,35], for the treatment of unroofed coronary sinus [36] and more-complex grown-up congenital heart disease [37], have been reported. Although the proportion of patients undergoing minimal-access approaches is relatively small, all conclude that this approach is as safe and effective as conventional median sternotomy.…”