Management algorithm for pulmonary vein stenosis: An evaluation of available surgical data

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Thoracic Surgery

Background:

• Pulmonary vein stenosis (PVS) is a rare but severe complication following radiofrequency ablation for atrial fibrillation.
• High-grade PVS significantly impacts patient hemodynamics and quality of life.
• Current interventional treatments like balloon angioplasty or stenting have high restenosis rates, necessitating exploration of other options.

Purpose of the Study:

• To conduct a structured literature review on surgical treatment strategies for PVS.
• To develop a pragmatic management algorithm for individualized treatment decisions in severe or recurrent PVS.
• To integrate findings with multidisciplinary clinical experience.

Main Methods:

• A structured literature review was performed using PubMed, adhering to the population, intervention, comparison, and outcome (PICO) framework.
• A decision flowchart was designed to create a treatment algorithm.

Main Results:

• Seven publications detailing 11 cases of cardiothoracic surgical treatment for PVS were identified.
• Common surgical techniques included pericardial patchplasty, sutureless procedures, endarterectomy, bypass, and widening plasty.
• Other described methods involved direct vein suturing to the left auricle or using pulmonary homograft tissue.

Conclusions:

• Management of PVS, particularly restenosis, remains challenging.
• Multidisciplinary team discussion (cardiology, radiology, thoracic surgery) is crucial for optimal patient care.
• A proposed treatment algorithm can aid in individualized decision-making and serve as a foundation for future research and clinical practice.