Outcomes after surgical repair of sinus venosus atrial septal defect in children

Objectives: Review of outcomes for children undergoing surgical repair of sinus venosus atrial septal defect (SVASD) and proposal of optimal treatment strategy. Background: Unlike secundum-type atrial septal defect (ASD II), surgical correction of SVASD is more challenging and carries higher risk of postoperative complications. Several surgical techniques have been proposed to avoid them; however, the data on long-term follow-up are limited. Methods: Between 1992-2005, 85 patients underwent surgery for SVASD at our institution. 78 and 7 operations were performed through full and partial sternotomy, respectively. The mean age was 7.7 years (2 months - 19 years). All patients with SVASD and no partial anomalous pulmonary venous drainage (PAPVD) or PAPVD in right atrium (n = 24) underwent the single-patch repair. Among patients with SVASD and PAPVD in SVC, 22 and 39 patients underwent intracaval baffle and Warden procedure, respectively. Clinical, electrocardiographic and echocardiographic follow-ups were available for all patients. Results: There were no deaths, reoperations, residual atrial septal defects and pulmonary vein stenosis. Two patients had SVC stenosis. Permanent arrhythmias were noted in 24 patients (28.2%). The rate of new arrhythmias in the intracaval baffle and Warden subgroup was 54.6% vs 23.1% (p = 0.01). Moreover, two and one patient from the intracaval baffle subgroup receive antiarrhythmics and had a pacemaker implanted, respectively. Conclusion: Surgical treatment of SVASD is associated with excellent results and minimal morbidity. The Warden procedure is preferred in patients with SVASD and PAPVD in SVC because of lower incidence of postoperative arrhythmias (Tab. 1, Fig. 4, Ref 23).