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The impact of the superior cavo-atrial incision in children and adults.
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  • Lamia Ait-Ali,
  • antonio ravaglioli,
  • Pierluigi Festa,
  • Alessandro Tamburrini,
  • Chiara Marrone,
  • Magdalena Cuman,
  • Cecilia Farnetani,
  • Vitali Pak,
  • Mario Chiavarelli,
  • Duccio Federici
Lamia Ait-Ali
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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antonio ravaglioli
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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Pierluigi Festa
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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Alessandro Tamburrini
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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Chiara Marrone
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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Magdalena Cuman
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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Cecilia Farnetani
Azienda Ospedaliera Universitaria Senese
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Vitali Pak
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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Mario Chiavarelli
Azienda Ospedaliera Universitaria Senese
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Duccio Federici
Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica
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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.