A Wide Comparison of Techniques for Repair of PAPVCs: One Institution's 20-Year Experience

Abstract

Background Different methods for surgical correction of partial anomalous pulmonary venous connection (PAPVC) exist. We evaluated the outcomes of four techniques regarding morbidity and mortality.

Methods A total of 116 patients underwent PAPVC repair in our institution over a period of 20 years. Single-patch technique (n = 82 [71%], mean age: 18.59 ± 20.49 years), double-patch technique (n = 13 [11%], mean age: 43.18 ± 25.14 years), Warden's technique (n = 7 [6%], mean age: 10.04 ± 10.47 years), and direct implantation of anomalous pulmonary veins (n = 14 [12%], mean age: 14.42 ± 18.58 years) were examined.

Results Out of the 116 patients, one patient (0.9%) developed pulmonary hypertension after discharge and three patients (2.6%) with normal right cardiac function showed right ventricular failure. In total, a pacemaker was inserted in seven cases (6%). Three patients (2.6%) presented with persistent nonsinus rhythm during follow-up. This complication was most frequently seen in the double-patch group being significantly increased compared with the other groups (p = 0.035). One patient presented with a mild stenosis of the superior vena cava. There were two early, nonsurgery-related deaths and no late mortality.

Conclusion Operative therapy of PAPVC has low postoperative morbidity and mortality. Therefore, surgical repair of this cardiac anomaly is a safe and reproducible treatment independent of the applied method. The surgical technique must be selected based on the anatomy and possible accompanying congenital heart defects. Special care should be taken when using the double-patch technique because of significant more frequent nonsinus rhythm events postoperatively.

Keywords

congenital heart diseases - outcomes - pediatric - surgery - complications

Financial Support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Ethical Standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. This study was approved by the ethics committee at our institution (S-056/2017).

• References

• 1 Siddiqui WT, Parveen S, Siddiqui MT, Amanullah MM. Clinical outcomes of surgically corrected atrial septal defects. J Pak Med Assoc 2013; 63 (05) 662-665
• 2 Thangarajah A. A rare case of isolated partial anomalous pulmonary venous connection to the inferior vena cava. J Clin Diagn Res 2015; 9 (03) TJ01-TJ02
• 3 Zubritskiy A, Arkhipov A, Khapaev T. , et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg 2016; 22 (02) 225-227
• 4 Kim C, Cho YH, Lee M. , et al. Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap. Korean J Thorac Cardiovasc Surg 2014; 47 (02) 94-99
• 5 Szychta W, Cerin G, Popa BA. , et al. Atypical abnormal pulmonary vein drainage with atrial septal defect: surgical treatment. Echocardiography 2015; 32 (06) 1040-1043
• 6 Aboukhoudir F, Aboukhoudir I, Pansieri M, Khennine B, Hirsch JL, Rekik S. [Partial anomalous pulmonary venous return in a 64-year-old woman]. Ann Cardiol Angeiol (Paris) 2015; 64 (05) 394-398
• 7 Doty DB, Doty JR. Cardiac Surgery: Operative Technique. 2nd ed. 2012. Austin, Texas: Elsevier;
• 8 Kumar T, Patra S, Ramalingam R, Agrawal N, Agarwal A, Manjunath CN. Pulmonary hypertension due to presence of isolated partial anomalous pulmonary venous connection: a case report. J Cardiovasc Dis Res 2013; 4 (04) 239-241
• 9 Aguilar Jiménez JM, Torres EG, Arlati F, Comas Íllas JV. Unnoticed bilateral partial anomalous pulmonary vein connection. J Thorac Cardiovasc Surg 2015; 149 (03) e40-e42
• 10 van de Woestijne PC, Verberkmoes N, Bogers AJ. Partial anomalous pulmonary venous connection (including scimitar syndrome). Multimed Man Cardiothorac Surg 2013; 2013: mmt001
• 11 Galetta D, Veronesi G, Leo F, Solli P, Spaggiari L. Anomalous right upper lobe venous drainage. Ann Thorac Surg 2006; 82 (06) 2272-2274
• 12 Ojaghi Haghigh Z, Sadeghpour A, Alizadehasl A. Isolated right sided anomalous pulmonary venous connection associated with significant right ventricular enlargement and intact interatrial septum. J Cardiovasc Thorac Res 2012; 4 (04) 123-124
• 13 Said SM, Burkhart HM, Schaff HV. , et al. Single-patch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: does it matter?. J Thorac Cardiovasc Surg 2012; 143 (04) 896-903
• 14 Pathi V, Guererro R, MacArthur KJ, Jamieson MP, Pollock JC. Sinus venosus defect: single-patch repair with caval enlargement. Ann Thorac Surg 1995; 59 (06) 1588-1589
• 15 Buz S, Alexi-Meskishvili V, Villavicencio-Lorini F. , et al. Analysis of arrhythmias after correction of partial anomalous pulmonary venous connection. Ann Thorac Surg 2009; 87 (02) 580-583
• 16 Iyer AP, Somanrema K, Pathak S, Manjunath PY, Pradhan S, Krishnan S. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 2007; 133 (03) 656-659
• 17 Kottayil BP, Dharan BS, Menon S. , et al. Anomalous pulmonary venous connection to superior vena cava: Warden technique. Eur J Cardiothorac Surg 2011; 39 (03) 388-391
• 18 Gustafson RA. Cavo-atrial anastomosis technique for partial anomalous pulmonary venous connection to the superior vena cava&–the Warden procedure. Oper Tech Thorac Cardiovasc Surg 2006; 11 (01) 22-32
• 19 Shahriari A, Rodefeld MD, Turrentine MW, Brown JW. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg 2006; 81 (01) 224-229 , discussion 229–230
• 20 Okonta KE, Agarwal V. Does Warden's procedure reduce sinus node dysfunction after surgery for partial anomalous pulmonary venous connection?. Interact Cardiovasc Thorac Surg 2012; 14 (06) 839-842
• 21 Naimo PS, d'Udekem Y, Brizard CP, Konstantinov IE. Outcomes of repair of left partial anomalous pulmonary venous connection in children. Interact Cardiovasc Thorac Surg 2015; 21 (02) 254-256
• 22 Koester S, Lee JZ, Lee KS. Pulmonary hypertension secondary to partial anomalous pulmonary venous return in an elderly. Case Rep Cardiol 2016; 2016: 8609282
• 23 Beyersdorf F. The use of controlled reperfusion strategies in cardiac surgery to minimize ischaemia/reperfusion damage. Cardiovasc Res 2009; 83 (02) 262-268
• 24 Stewart RD, Bailliard F, Kelle AM, Backer CL, Young L, Mavroudis C. Evolving surgical strategy for sinus venosus atrial septal defect: effect on sinus node function and late venous obstruction. Ann Thorac Surg 2007; 84 (05) 1651-1655 , discussion 1655
• 25 Park CS, Kwak JG, Lee C. , et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg 2012; 41 (02) 261-265
• 26 Fragata J, Magalhães M, Baquero L, Trigo C, Pinto F, Fragata I. Partial anomalous pulmonary venous connections: surgical management. World J Pediatr Congenit Heart Surg 2013; 4 (01) 44-49
• 27 Attenhofer Jost CH, Connolly HM, Danielson GK. , et al. Sinus venosus atrial septal defect: long-term postoperative outcome for 115 patients. Circulation 2005; 112 (13) 1953-1958
• 28 Friedli B, Guérin R, Davignon A, Fouron JC, Stanley P. Surgical treatment of partial anomalous pulmonary venous drainage. A long-term follow-up study. Circulation 1972; 45 (01) 159-170
• 29 Hsu CY, Wu ET, Chen SJ, Chen YS, Huang SC. Modified Warden procedure using the concept of senning operation: repair without any patch. Ann Thorac Surg 2015; 100 (05) 1917-1919
• 30 Walker RE, Mayer JE, Alexander ME, Walsh EP, Berul CI. Paucity of sinus node dysfunction following repair of sinus venosus defects in children. Am J Cardiol 2001; 87 (10) 1223-1226 , A8