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Surgical Results of the Superior Vena Cava Intimal Layer-Only Suture Technique in Heart Transplantation
Sang-Uk Park1, Kyungsub Song1, Yun Seok Kim1
1Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
Insights
This study shows that using only the intima layer for superior vena cava (SVC) sutures during heart transplantation is safe and effective. This technique prevents SVC stenosis, a common post-transplant complication.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Vascular Surgery
Background:
- Superior vena cava (SVC) stenosis is a significant concern following heart transplantation.
- Various surgical modifications aim to mitigate this complication.
- The SVC intima layer-only suture technique is evaluated for its efficacy.
Purpose of the Study:
- To analyze the surgical outcomes of the SVC intima layer-only suture technique in heart transplantation.
- To assess the incidence and severity of SVC stenosis post-transplantation using this method.
Main Methods:
- The SVC anastomosis was performed using sutures placed solely in the intima.
- SVC area was measured at three points (above, at, and below anastomosis) via cardiac CT.
- Patients with 2-year postoperative CT follow-up between June 2017 and May 2020 were included.
Main Results:
- Forty-one patients underwent heart transplantation; 24 had 2-year CT follow-up.
- No postoperative bleeding requiring intervention was observed.
- Mean SVC areas at follow-up showed no significant difference (p=0.996), and no SVC stenosis symptoms occurred.
Conclusions:
- The SVC intima layer-only suture technique is a safe and effective surgical option.
- This method appears to prevent the development of SVC stenosis after heart transplantation.
Background:
Superior vena cava (SVC) stenosis during follow-up is a major concern after heart transplantation, and many technical modifications have been introduced. We analyzed the surgical results of the SVC intima layer-only suture technique in heart transplantation.
Methods:
We performed SVC anastomosis with sutures placed only in the intima during heart transplantation. We measured the area of the SVC at 3 different points (above the anastomosis, at the anastomosis, and below the anastomosis) in an axial view by freely drawing regions of interest, and then evaluated the degree of stenosis. Patients who underwent cardiac computed tomography (CT) at 2 years postoperatively between June 2017 and May 2020 were included in this study.
Results:
We performed heart transplantation in 41 patients. Among them, 24 patients (16 males and 8 females) underwent follow-up cardiac CT at 2 years postoperatively. The mean age at operation was 49.4±4.9 years. The diagnoses at time of operation were dilated cardiomyopathy (n=12), ischemic heart disease (n=8), valvular heart disease (n=2), hypertrophic cardiomyopathy (n=1), and congenital heart disease (n=1). No cases of postoperative bleeding requiring intervention occurred. The mean CT follow-up duration was 1.9±0.7 years. At follow-up, the mean areas at the 3 key points were 2.7±0.8 cm2, 2.7±0.8 cm2, and 2.7±1.0 cm2 (p=0.996). There were no SVC stenosis-related symptoms during follow-up.
Conclusion:
The suture technique using only the SVC intimal layer is a safe and effective method for use in heart transplantation.
