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Evolution and Current Results of a Unified Strategy for Sinus Venosus Surgery

Stephens, E. H.; Mongé, M. C.; Eltayeb, O.; Patel, A.; Webster, G.; Cornicelli, M. D.; Kennedy, C.; Popescu, A. R.; Rigsby, C. K.; Backer, C. L.

Ann Thorac Surg. 2020 May 22

Abstract

BACKGROUND: Given recent reports of percutaneous closure of sinus venosus atrial septal defects (SVASD), we reviewed our experience with surgical repair. Due to the high incidence of arrhythmias with the two-patch technique, since 2001 we have used either one-patch repairs or the Warden procedure. METHODS: A retrospective review was performed of pediatric patients undergoing SVASD at our institution from 1/1/1990 to 7/1/2018. Standard demographic data such as echocardiographic and cross-sectional imaging, along with operative details, and clinical echocardiographic outcomes were collected. RESULTS: The cohort included 144 patients with a median age of 4.3 (8.5) years. Inferior SVASD was present in 24 patients (17%). A single autologous untreated pericardial patch was used for 114 patients (79%), a two-patch technique in 20 patients (14%, last performed in 2000), and a Warden procedure in 10 patients (7%). Median length-of-stay was 4 (2) days. On echocardiogram follow-up no patient had pulmonary vein stenosis. One patient who had the Warden procedure required a balloon dilation of the superior caval vein 2 years postoperatively and a stent 3 years later. Two-patch patients were substantially less likely to be in normal sinus rhythm (41%) on postoperative ECGs compared to the other two techniques (81% one-patch and 89% Warden, p=0.02). CONCLUSIONS: The great majority of patients with SVASD can be successfully repaired with a single patch of autologous pericardium. We transitioned to using either a single pericardial patch or the Warden procedure resulting in a higher frequency of normal sinus rhythm on postoperative ECGs.

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