Outcomes of the lateral caval flap and conventional techniques for repair of right-sided partial anomalous pulmonary venous connection in adults.

Objective: In an effort to overcome limitations of conventional techniques for surgical repair of partial anomalous pulmonary venous connection (PAPVC), we developed the lateral caval flap (LCF) technique, which leverages a native endocardial surface to create unobstructed recruitment of the anomalous pulmonary veins to the left atrium. In this study, we report the long-term outcomes of the LCF and conventional techniques for repair of right-sided PAPVC.

Methods: In total, 109 adult patients (mean age 48 years; 57% male) who underwent right-sided PAPVC repair (53 LCF, 34 single-patch, 13 double-patch, 7 pericardial roll, and 2 Warden procedure) from 1997 to 2022 were retrospectively reviewed. Outcomes included operative mortality, major morbidity, arrythmias, systemic and pulmonary venous pathway obstruction, survival, and reintervention.

Results: Operative mortality was 1% and there were no in-hospital deaths after LCF repair; 4 patients had strokes (4%) including 2 nondisabling strokes after LCF repair (4%), 19 patients developed new postoperative atrial fibrillation/flutter (24%) including 9 after LCF repair (24%), and 27 patients developed new early sinus node dysfunction (26%) including 13 after LCF repair (26%). Although sinus-node dysfunction was transient in most patients, 7 required permanent pacemaker implantation (7%). Survival at 1, 5, 10, and 15 years was 95%, 89%, 86%, and 81%, respectively. At a median follow-up of 6 years, 9 patients developed systemic or pulmonary venous pathway obstruction. Freedom from cardiac reintervention at 5 years was 89% overall and 98% after LCF repair.

Conclusions: All of the described techniques for repair of right-sided PAPVC yielded acceptable short- and long-term outcomes. LCF is a valid technique for right-sided PAPVC repair with a low risk of venous pathway obstruction compared with conventional techniques. Sinus node dysfunction and atrial tachyarrhythmias remain challenges.