Preserving Pathways: Strategies for Left Superior Vena Cava Management in Pediatric Cardiac Surgery

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Anatomical Variations

Background:

• Persistent left superior vena cava (PLSVC) is a common congenital anomaly.
• Surgical intervention is necessary for significant shunting or during heart transplantation.
• Systematic studies comparing LSVC repatriation methods are lacking.

Purpose of the Study:

• To compare the patency rates of different surgical methods for LSVC repatriation.
• To evaluate the long-term outcomes of LSVC reconstruction techniques.

Main Methods:

• Retrospective review of 22 patients undergoing LSVC surgical management (2013-2023).
• Patients categorized into Coronary Sinus (CS), Systemic Vein (SV), or Atrial Baffle (AB) groups.
• Primary outcome: LSVC patency rate in each group.

Main Results:

• Atrial baffle (AB) group showed 100% patency (9/9 patients).
• Coronary sinus (CS) group had 75% patency (3/4 patients).
• Systemic vein (SV) group had 33% patency (3/9 patients).
• Patency was associated with older age (>2 years) and higher weight.

Conclusions:

• Atrial baffle and coronary sinus reunion may offer superior LSVC patency.
• Methods preserving LSVC anatomy or using intracardiac baffles are favorable.
• Older, heavier patients may experience better outcomes with LSVC reconstruction.