The different surgical impact of the superior cavoatrial incision in children and adults

Abstract

Introduction: The single- and double-patch repairs are undoubtedly the most commonly used techniques for the surgical management of partial anomalous pulmonary venous connection associated with sinus venosus atrial septal defect. The aim of this study was to retrospectively compare early and long-term surgical outcomes in paediatric and adult patients, focusing in particular on the occurrence of ectopic atrial rhythm. Material and methods: Seventy patients (male: 38, 54.2%) underwent surgical repair for partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. Forty-nine patients (70%) underwent surgical repair in paediatric age (<16 years old), while 21 of (30%) patients were operated in adulthood. Thirty patients (42.8%) underwent single-patch repair and 39 patients (55.7%) underwent double-patch repair. In only one patient, the Warden procedure was performed (1.4%). Median follow-up time was 52 months (IQ 15.1–113). Results: The type of surgical technique didn’t affect the incidence of ectopic atrial rhythm (26.6% in single-patch group and 25.6% in double-patch groups, p = 0.9). At long-term follow-up, ectopic atrial rhythm, as an expression of sinoatrial node disturbance, was however significantly more frequent in the paediatric population (28.8% paediatric group and 4.7% adult group, p = 0.02). Conclusions: The higher incidence of ectopic atrial rhythm in children is probably related to the closer position of the sinus node to the superior cavoatrial incision, which makes irreversible iatrogenic traumatism more likely to occur. Surgical techniques that avoid any manipulation on the superior cavoatrial junction should, therefore, be preferred for children undergoing partial anomalous pulmonary venous connection repair.

Outcomes Following Surgical Repair of Sinus Venosus Atrial Septal Defects: A Systematic Review and Meta‐Analysis

“…A total of 141 full‐text articles were retained after the screening of titles and abstracts using the exclusion criteria. Full‐text articles were reviewed, and 39 studies meeting the inclusion criteria were included for qualitative and quantitative synthesis 6 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 (Table 1 ). According to the Newcastle–Ottawa Scale, no study had a low risk of bias, 39 had moderate risk, and 1 had high risk of bias 6 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , …”

“…Across 40 studies, 1320 patients underwent SVASD repair. 6 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 Most patients (88.0%) had associated partial anomalous pulmonary venous connection. A persistent left‐sided superior vena cava was the second most common associated lesion found in 79 (20.8%) patients across 7 studies.…”

“…The type of repair in these instances was inconsistently reported (Table 1 ). 23 , 34 , 44 , 45 Among the 5 significant cases, 1 patient refused corrective surgery and 1 patient had not had intervention at the time of publication. 28 , 29 The remaining 3 patients were successfully managed, 1 with surgery, another with balloon angioplasty, and the last with stenting.…”