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Caval Division With Autologous Reconstruction: Partial Anomalous Pulmonary Venous Connection Entering The Proximity Of Cavoinnominate Junction
Lauren Mathis1, Danielle Crethers2, Bert Buckman1, Brendan Shafer1, Michael Jensen3, Anastasios C. Polimenakos1.
1Children's Hospital of Georgia, Augusta, GA, USA, 2Medical College of Georgia, Augusta, GA, USA, 3Augusta University, Augusta, GA, USA.

OBJECTIVES:Correction of partial anomalous pulmonary venous connection(PAPVC) to the superior vena cava(SVC) can be complicated by rhythm disturbance, SVC or pulmonary venous(PV) obstruction. A combined in-situ cavoatrial autologous reconstruction and atrial appendage advancement flap(CARAF) was used after SVC division at the cavoinnominate junction(CIVJ)
METHODS:Between September 2014-August 2018 21 consecutive patients with PAPVC were identified. Six patients(Group-A) were associated with PV connection to SVC near CIVJ and underwent CARAF. Autologous pericardium was used at the base of atrial appendage with no patch involving the cavoatrial anastomosis. Group-A was compared to patients with PAPVC not related to CIVJ(Group-B) who underwent alternative repair(n=15). Median age was 8.3(IQR:4.2-18.5) years for Group-A (vs 11.9; IQR:8.8-34.7 in Group-B) (p=0.07). In Group-A 4(67%) had an atrial septal defect (vs 12[80%] in Group-B; p=0.8). None had left SVC in Group-A (vs 1 in Group-B; p=0.9). All underwent preoperative advanced imaging to evaluate PV anatomy. Follow-up was complete(median 2.9; IQR:1.2-3.7 years). Freedom from rhythm disturbance, SVC or PV obstruction was assessed.
RESULTS:There were no early/late deaths. Hospital length of stay was 3.2+/-0.5 days. No dysrhythmias or sinus node dysfunction occurred during the perioperative period in Group-A (1 in Group-B; p=0.9). There was no tricuspid valve insufficiency, need for pacemaker or 30-day readmissions. All patients(groups:A-B) remained in normal sinus rhythm with no systemic or PV obstruction at last follow-up.
CONCLUSIONS:CARAF appears to be effective and reproducible with no associated morbidity in cases where conventional strategies might carry risk for rhythm disturbance and caval or PV obstruction.