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.