Faculty Collaboration Database

Reintervention for Superior Vena Cava Obstruction After Heart Transplant. Ann Thorac Surg 2024 Jan;117(1):198-204

Date

08/08/2022

Pubmed ID

35934067

DOI

10.1016/j.athoracsur.2022.07.033

Scopus ID

2-s2.0-85136662356 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Children undergoing orthotopic heart transplant (OHT) may require complex reconstruction of superior vena cava (SVC) anomalies. SVC anatomy and mode of reconstruction are potential risk factors for SVC obstruction.

METHODS: A retrospective single-center review was conducted of patients undergoing initial OHT between January 1, 1990, and July 1, 2021. Simple SVC anatomy included a single right SVC to the right atrium or bilateral SVCs with a left SVC to an intact coronary sinus, without prior superior cavopulmonary connection. Presence of anomalous SVC anatomy, superior cavopulmonary connection, or previous atrial switch operation defined complex anatomy. Reconstructive strategies included atrial anastomosis; direct SVC-to-SVC anastomosis; and augmented SVC anastomosis using innominate vein, patch, cavopulmonary connection, or interposition graft. The primary outcome was reintervention for SVC obstruction.

RESULTS: Of 288 patients, pretransplant diagnoses included congenital heart disease (n = 155 [54%]), cardiomyopathy (n = 125 [43%]), and other (n = 8 [3%]). Most (n = 208 [72%]) had simple SVC anatomy compared with complex SVC anatomy (80 [28%]). Reintervention for SVC obstruction occurred in 15 of 80 (19%) with complex anatomy and 1 of 208 (0.5%) with simple anatomy (P = .0001). Reintervention was more common when innominate vein or a patch was used (9/25 [36%]) compared with an interposition graft (1/7 [14%]) or direct anastomosis (6/82 [7%]; χ² = 13.1; P = .001). Most reinterventions occurred within 30 days of OHT (14/16 [88%]).

CONCLUSIONS: Patients with complex SVC anatomy have a higher rate of reintervention for SVC obstruction after OHT compared with those with simple SVC anatomy. In cases of complex SVC anatomy, interposition grafts may be associated with less reintervention compared with complex reconstructions using donor tissue.

Author List

Aronowitz DI, Geoffrion TR, Burstein D, White RM, McHugh-Grant S, Mavroudis CD, Nuri MAK, Maeda K, Chen JM, Mascio CE, Gaynor JW, Fuller S

Author

Tracy R. Geoffrion MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Heart Atria
Heart Transplantation
Humans
Retrospective Studies
Superior Vena Cava Syndrome
Vena Cava, Superior