Frankel William C, Kindzelski Bogdan A, Yang Benjamin, Mahboubi Rashed, Hammoud Miza Salim, Toth Andrew J, Najm Hani K, Pettersson Gösta B, Karamlou Tara
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Division of Cardiothoracic Surgery, Corewell East William Beaumont University Hospital, Royal Oak, Mich.
JTCVS Open. 2024 Oct 28;23:225-234. doi: 10.1016/j.xjon.2024.10.023. eCollection 2025 Feb.
In an effort to overcome limitations of conventional techniques for surgical repair of partial anomalous pulmonary venous connection (PAPVC), we developed the lateral caval flap (LCF) technique, which leverages a native endocardial surface to create unobstructed recruitment of the anomalous pulmonary veins to the left atrium. In this study, we report the long-term outcomes of the LCF and conventional techniques for repair of right-sided PAPVC.
In total, 109 adult patients (mean age 48 years; 57% male) who underwent right-sided PAPVC repair (53 LCF, 34 single-patch, 13 double-patch, 7 pericardial roll, and 2 Warden procedure) from 1997 to 2022 were retrospectively reviewed. Outcomes included operative mortality, major morbidity, arrythmias, systemic and pulmonary venous pathway obstruction, survival, and reintervention.
Operative mortality was 1% and there were no in-hospital deaths after LCF repair; 4 patients had strokes (4%) including 2 nondisabling strokes after LCF repair (4%), 19 patients developed new postoperative atrial fibrillation/flutter (24%) including 9 after LCF repair (24%), and 27 patients developed new early sinus node dysfunction (26%) including 13 after LCF repair (26%). Although sinus-node dysfunction was transient in most patients, 7 required permanent pacemaker implantation (7%). Survival at 1, 5, 10, and 15 years was 95%, 89%, 86%, and 81%, respectively. At a median follow-up of 6 years, 9 patients developed systemic or pulmonary venous pathway obstruction. Freedom from cardiac reintervention at 5 years was 89% overall and 98% after LCF repair.
All of the described techniques for repair of right-sided PAPVC yielded acceptable short- and long-term outcomes. LCF is a valid technique for right-sided PAPVC repair with a low risk of venous pathway obstruction compared with conventional techniques. Sinus node dysfunction and atrial tachyarrhythmias remain challenges.
为克服部分性肺静脉异位连接（PAPVC）外科修复传统技术的局限性，我们开发了外侧腔静脉瓣（LCF）技术，该技术利用天然心内膜表面，使异常肺静脉无阻碍地汇入左心房。在本研究中，我们报告了LCF和传统技术修复右侧PAPVC的长期结果。
回顾性分析了1997年至2022年期间接受右侧PAPVC修复的109例成年患者（平均年龄48岁；57%为男性）（53例行LCF修复、34例行单补片修复、13例行双补片修复、7例行心包卷修复、2例行Warden手术）。结果包括手术死亡率、主要并发症、心律失常、体循环和肺静脉通路梗阻、生存率和再次干预情况。
手术死亡率为1%，LCF修复后无院内死亡；4例患者发生中风（4%），其中LCF修复后2例为非致残性中风（4%）；19例患者术后出现新发心房颤动/扑动（24%），其中LCF修复后9例（24%）；27例患者出现新发早期窦房结功能障碍（26%），其中LCF修复后13例（26%）。尽管大多数患者的窦房结功能障碍是短暂的，但7例患者需要植入永久起搏器（7%）。1年、5年、10年和15年的生存率分别为95%、89%、86%和81%。中位随访6年时，9例患者出现体循环或肺静脉通路梗阻。5年时无心脏再次干预的总体自由度为89%，LCF修复后为98%。
所有描述的右侧PAPVC修复技术均产生了可接受的短期和长期结果。与传统技术相比，LCF是一种有效的右侧PAPVC修复技术，静脉通路梗阻风险较低。窦房结功能障碍和房性快速心律失常仍然是挑战。
