Evolution And Current Results Of A Unified Strategy For Sinus Venosus Surgery
Elizabeth H. Stephens, MD, Michael C. Monge, MD, Osama M. Eltayeb, MD, Angira Patel, MD, Gregory Webster, MD, Cynthia K. Rigsby, MD, Carl L. Backer, MD.
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA.
Objective(s): In a review of our series from 2007 we noted a high incidence of junctional or low atrial rhythm when using a two-patch technique for sinus venosus atrial septal defects (SVASD). Because of this, over the last 15 years our surgical strategy has avoided two-patch repairs and we have used either one-patch repairs or the Warden procedure.
Methods: Between 1990 - 2018, 144 patients underwent repair of SVASD at our institution. Median age was 4.4 years. Partial anomalous pulmonary venous connection (PAPVC) was present in 135 patients (94%). A single autologous pericardial patch placed through a right atrial incision was used for 114 patients (79%), a two-patch technique in 23 patients (16%), and a Warden procedure in 10 patients (7%).
Results: Median length of stay was 4 days. Since 2010 low atrial or junctional rhythm requiring temporary pacing occurred in 2 of 63 patients (3%). This compared to 12 of 22 patients (55%) with low atrial or junctional rhythm after the two-patch repair in our prior review (p<0.001). On echocardiogram follow-up no patient had pulmonary vein stenosis. Three patients had very mild superior caval vein narrowing and one Warden patient required a superior caval vein stent 3 years postoperatively.
Conclusions: The great majority of patients with SVASD and PAPVC can be successfully repaired with a single patch of autologous pericardium. We transitioned in the year 2001 to using either a single pericardial patch or the Warden procedure with improved maintenance of normal sinus rhythm.