Is double or single patch for sinus venosus atrial septal defect repair the better option in prevention of postoperative venous obstruction?

Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital, Ibadan, Nigeria.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 08/2012; 15(5):900-3. DOI: 10.1093/icvts/ivs369
Source: PubMed


A best evidence topic in cardiac surgery was constructed according to a structured protocol. The question addressed was, 'Is double or single patch for sinus venous atrial septal defect repair the better option in prevention of postoperative venous obstruction?' Altogether seventy nine papers were found using the reported search; ten papers were identified that provided the best evidence to answer the question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results of were tabulated. Three hundred and thirty four patients had single-patch with 7 (2.1%) having venous obstruction (venous obstruction; defined as obstruction at the atriocaval anastomosis and/or the right superior pulmonary vein) while 130 had double-patch with 3 (2.3%) having venous obstruction. However, when the three randomised studies were reviewed, 101 had single-patch and 67 had double-patch with 7 (7%) and 4 (6%) having venous obstruction respectively. Similarly, another randomised study that considered solely the two surgical options with eighteen patients who had single-patch repair as group A and 19 patients who had double-patch repair as group B with six patients in group A and 2 patients in group B having significant superior vena cava-right atrium pressure gradient of more than 6 mmHg. Nine patients in group A had a significant gradient causing turbulence across the right superior pulmonary vein at the level of the patch, whereas no patients in group B had turbulence across the pulmonary vein. The double-patch technique technically offered better results in terms of superior vena cava narrowing and gradient across the pulmonary vein without any increase in complications. However, in order to reduce postoperative venous obstruction while using the single-patch repair method, the adoption of the transcaval approach yielded excellent results, with unobstructed pulmonary and systemic venous flow as in 141 patients who had this method of repair only one patient had venous obstruction. In conclusion, the evidence was in support of the adoption of double-patch or the use of the transcaval repair technique when the single patch technique was used as a better option to avoid venous obstruction.

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Available from: Kelechi E. Okonta, Feb 13, 2015
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    ABSTRACT: Background: Superior sinus venosus atrial septal defect (SV-ASD) is an interatrial defect with partial anomalous pulmonary venous connection (PAPVC) draining into the right atrium. The principle for SV-ASD surgical repair involves redirecting the pulmonary venous blood back to the left atrium and closure of the atrial septal defect without compromising the adjoining structures. Methods: We reviewed English literature relating to this topic via a MEDLINE and Google scholar search using the following terms: surgery for sinus venosus atrial septal defect (SV-ASD), surgery for partial anomalous pulmonary venous connection (PAPVC) and complications of the surgery. Results: A total of 910 consecutive cohort patients with different surgical options between 1984 to 2012 were analyzed. The breakdown showed that 291(32.0%) had single-patch, 275(30.2%) had Warden’s procedure, 185(20.3%) had a double-patch and 159(17.5%) had use of autologous right atrial appendage for the anastomosis. The total follow-up was between 0.008-30 years. Sinus node dysfunction (SND) was the commonest complication occurring mostly in patients who had double-patch technique 16(8.6%) followed by 15(5.5%) patients with single-patch technique, 7(4.4%) patients in whom right atrial appendage was used and 5(1.8%) patients with Warden’s procedure. Venous obstruction occurred in 22(7.7%) patients with SP, 13(5.1%) patients with Warden’s Procedure and 5(2.7%) patients with double-patch. Conclusion: The two major complications, SND and venous obstruction, assumed a see-saw approach as surgical maneuvers avoiding venous obstruction encouraged SND and vice versa. However, adopting surgical options which avoided incision across the Cavoatrial junction attenuated all the complications. KEYWORDS Sinus Venosus-Atrial Septal Defect; Warden’s Procedure; Right Atrial Appendage; Single-Patch Technique; Double-Patch Technique
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