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The different surgical impact of the superior cavoatrial incision in children and adults

Published online by Cambridge University Press:  15 December 2020

Lamia Ait-Ali ,
Antonio Ravaglioli Open the ORCID record for Antonio Ravaglioli [Opens in a new window] ,
Pierluigi Festa ,
Alessandro Tamburrini ,
Chiara Marrone ,
Magdalena Cuman ,
Cecilia Farnetani ,
Vitali Pak ,
Mario Chiavarelli  and
Duccio Federici
Lamia Ait-Ali
Affiliation:
Department of cardiology, Institute of Clinical Physiology, CNR, Massa, Italy
Antonio Ravaglioli*
Affiliation:
Division of Pediatric Cardiac Surgery, Department of cardiac surgery, Fondazione G. Monasterio, Massa, Italy
Pierluigi Festa
Affiliation:
Division of Pediatric Cardiology, Department of cardiology, Fondazione G. Monasterio, Massa, Italy
Alessandro Tamburrini
Affiliation:
Division of Cardiothoracic Surgery, Department of cardiac surgery, UHS, Southampton, UK
Chiara Marrone
Affiliation:
Division of Pediatric Cardiology, Department of cardiology, Fondazione G. Monasterio, Massa, Italy
Magdalena Cuman
Affiliation:
Division of Pediatric Cardiology, Department of cardiology, Fondazione G. Monasterio, Massa, Italy
Cecilia Farnetani
Affiliation:
Division of Cardiac Surgery, Department of cardiac surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
Vitali Pak
Affiliation:
Division of Pediatric Cardiac Surgery, Department of cardiac surgery, Fondazione G. Monasterio, Massa, Italy
Mario Chiavarelli
Affiliation:
Division of Cardiac Surgery, Department of cardiac surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
Duccio Federici
Affiliation:
Division of Pediatric Cardiac Surgery, Department of cardiac surgery, Fondazione G. Monasterio, Massa, Italy
*
Author for correspondence: Antonio Ravaglioli, Division of Pediatric Cardiac Surgery, Department of cardiac surgery, Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100, Massa, Italy. Tel: +39 3713921328; Fax: 0585 483524. E-mail: antonioravaglioli@gmail.com
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Abstract

Introduction:

The single- and double-patch repairs are undoubtedly the most commonly used techniques for the surgical management of partial anomalous pulmonary venous connection associated with sinus venosus atrial septal defect. The aim of this study was to retrospectively compare early and long-term surgical outcomes in paediatric and adult patients, focusing in particular on the occurrence of ectopic atrial rhythm.

Material and methods:

Seventy patients (male: 38, 54.2%) underwent surgical repair for partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. Forty-nine patients (70%) underwent surgical repair in paediatric age (<16 years old), while 21 of (30%) patients were operated in adulthood. Thirty patients (42.8%) underwent single-patch repair and 39 patients (55.7%) underwent double-patch repair. In only one patient, the Warden procedure was performed (1.4%). Median follow-up time was 52 months (IQ 15.1–113).

Results:

The type of surgical technique didn’t affect the incidence of ectopic atrial rhythm (26.6% in single-patch group and 25.6% in double-patch groups, p = 0.9). At long-term follow-up, ectopic atrial rhythm, as an expression of sinoatrial node disturbance, was however significantly more frequent in the paediatric population (28.8% paediatric group and 4.7% adult group, p = 0.02).

Conclusions:

The higher incidence of ectopic atrial rhythm in children is probably related to the closer position of the sinus node to the superior cavoatrial incision, which makes irreversible iatrogenic traumatism more likely to occur. Surgical techniques that avoid any manipulation on the superior cavoatrial junction should, therefore, be preferred for children undergoing partial anomalous pulmonary venous connection repair.

Keywords

Double-patch repairpartial anomalous pulmonary venous connection repairectopic atrial rhythmpaediatric population
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 5 , May 2021 , pp. 751 - 755
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Lamia Ait Ali and Antonio Ravaglioli contributed equally to this work.

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