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

Stephens EH, Mongé MC, Eltayeb O, Patel A, Webster G, Cornicelli MD, Kennedy C, Popescu AR, Rigsby CK, Backer CL.Ann Thorac Surg. 2020 May 10:S0003-4975(20)30711-6. doi: 10.1016/j.athoracsur.2020.03.113. Online ahead of print.PMID: 32437676



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.