Eastern Cardiothoracic Surgical Society

Long-term Outcomes After Sinus Venosus Atrial Septal Defect Repair: Impact of Early Repair and Role of Autologous Atrial Appendage Advancement Flap
Kiran K. Mallula1, Saad Siddique2, Kanwar Multani2, Ra-id Abdulla1, Chawki F. El-Zein2, Michel N. Ilbawi2, Anastasios C. Polimenakos1, 1Rush University Medical Center, Chicago, IL, 2Advocate Hope Children’s Hospital, Oak Lawn, IL

OBJECTIVE: Surgical correction of sinus venosus atrial septal defect(SVASD) carries substantial risk for dysrhythmias and systemic or pulmonary venous(PV) channels obstruction. Anomalous pulmonary veins(APV) are, often, associated with SVASD. Operative approach remains a matter of debate. Modified single-patch repair(MSP) with autologous atrial appendage advancement flap(MSP-AAF) is underutilized and long-term outcome, yet, to be determined.

METHODS: From January 1990 to December 2011 44 patients with SVASD repair were identified and data reviewed. Thirty-nine(89%) had superior SVASD and 38 APV. Operative approach was consistent with predominant use of MSP-AAF(n=36). In APV inserted high into the superior vena cava (SVC)MSP with caval division and cavo-atrial reconstruction (MSP-Warden) was applied. Perioperative and long-term outcomes were analyzed.

RESULTS: Mean age and weight at repair were 11.9+/-16.5 years and 31.2+/-25.2 Kg, respectively. There were no early or late deaths. One(2.6%) dysrhythmia (sick sinus syndrome) requiring pacemaker was accounted at hospital discharge. PV flow remained unobstructed. One(2.6%) patient (MSP-Warden) with SVC stenosis required intervention within 12 months after repair. Mean follow-up was 72.2+/-52.3 months.   Older age (>10 years) at repair was associated with more late morbid cardiac events(p<0.05). Freedom from re-intervention or dysrhythmias at last follow-up was statistically different (p<0.05) between the two age groups.

CONCLUSIONS: Surgical correction of SVASD with MSP-AAF carries low early and late cardiac morbidity with the added advantage of growth potential, particularly critical during early repair. Age at repair impacts freedom from late adverse cardiac phenomena. In APV inserted high into the SVC MSP-Warden is advocated.