The impact of the superior cavo-atrial incision in children and adults.
Abstract
Background and aim of the study The single- and double-patch repairs are
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 pediatric and adult
patients, focusing in particular on the occurrence of postoperative
rhythm disturbances. Methods 115 patients (male: 63, 54.8%) underwent
surgical repair for partial anomalous pulmonary venous connection with
sinus venosus atrial septal defect. 80 patients (70.4%) underwent
surgical repair in pediatric age (<16 years old), while 35
(29.6%) patients were operated in adulthood. 49 patients (42.6%)
underwent single-patch repair and 65 patients (56.5%) underwent
double-patch repair. In only one patient the Warden procedure was
performed (0,9%). Median follow-up time was 52 months (IQ 15.1-113).
Results The type of surgical technique didn’t affect the overall
incidence of all rhythm disturbances (41% in single patch group and
35% in double patch groups, p=0.5). At long-term follow-up, ectopic
atrial rhythm, as expression of sinoatrial node disturbance, was however
significantly more frequent in the pediatric population (32% pediatric
group and 8% adult group, p=0.02). Conclusions The higher incidence of
ectopic atrial rhythm in children is probably related to the closer
relationship of the sinus node to the superior cavo-atrial incision,
which makes iatrogenic traumatism more likely to occur. Surgical
techniques that avoid any manipulation on the superior cavo-atrial
junction should therefore be preferred for children undergoing partial
anomalous pulmonary venous connection repair.