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Preserving Pathways: Strategies for Left Superior Vena Cava Management in Pediatric Cardiac Surgery
Chen Chia Wang1, Harrison S Stuart2, David P Bichell1
1Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Surgical repair of persistent left superior vena cava (PLSVC) shows varying success rates. Atrial baffle and coronary sinus methods may offer better long-term patency for PLSVC compared to systemic vein redirection.
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.
Background:
Persistent left superior vena cava (LSVC) is a common congenital anomaly requiring operative management when it causes significant right-to-left shunting or during heart transplantation. Comparative patency of various LSVC repatriation methods to the right side of the heart has not been systematically studied.
Methods:
This is a single-institution, retrospective review of patients undergoing surgical management of LSVC from 2013 to 2023. Patients were grouped on the basis of the LSVC to right atrium path: coronary sinus (CS) group with LSVC-CS anastomosis; systemic vein (SV) group with LSVC drainage through donor superior vena cava, right atrial appendage, or innominate vein; or atrial baffle (AB) group. Our primary objective is LSVC patency rate in each group.
Results:
Twenty-two patients with a median age of 27 months met inclusion criteria; 4 patients were in the CS group, 9 in the SV group, and 9 in the AB group. At the time of collection, 3 (75%) patients in the CS group, 3 (33%) in the SV group, and 9 (100%) in the AB group showed LSVC patency. All patients demonstrating patency in CS and SV groups were older than 2 years, whereas all patients with occlusion (except for a 35-year-old patient) were younger than 2 years.
Conclusions:
Of the methods redirecting LSVC to the right atrium, patency may be best preserved with an undistorted LSVC reunited with a retained CS or redirected by an intracardiac baffle compared with methods that displace the LSVC. Older patients with higher weight may have better patency rates with LSVC reconstruction.
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