Ignacio Lugones MD, PhD, Antonio Gonzalez Calle MD, PhD, Ramón Pérez-Caballero MD, PhD, Giuseppe Pelella MD, Virginie Fouilloux MD, Inés A. Martínez MD, Veronica Laudani MD, Ashish Katewa MD, Héctor S. Díliz-Nava MD, Javier H. López Terrazas MD, Alexis J. Palacios Macedo-Quenot MD, Juan Miguel Gil-Jaurena MD, Daniel A. Klinger MD, Benjamin Chiostri MD, Andrés Rosso MD, Norberto Berber MD, María Sol De Los Santos MD, Natalia Troncoso MD, Victoria E. Zerpa Pacheco MD, Fernanda Biancolini MD, James D. St. Louis MD
{"title":"Mid-term results of the Lugones procedure for scimitar syndrome repair","authors":"Ignacio Lugones MD, PhD, Antonio Gonzalez Calle MD, PhD, Ramón Pérez-Caballero MD, PhD, Giuseppe Pelella MD, Virginie Fouilloux MD, Inés A. Martínez MD, Veronica Laudani MD, Ashish Katewa MD, Héctor S. Díliz-Nava MD, Javier H. López Terrazas MD, Alexis J. Palacios Macedo-Quenot MD, Juan Miguel Gil-Jaurena MD, Daniel A. Klinger MD, Benjamin Chiostri MD, Andrés Rosso MD, Norberto Berber MD, María Sol De Los Santos MD, Natalia Troncoso MD, Victoria E. Zerpa Pacheco MD, Fernanda Biancolini MD, James D. St. Louis MD","doi":"10.1016/j.xjtc.2026.102571","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to report the mid-term outcomes of the Lugones procedure (in situ pericardial rerouting technique) and its variants for scimitar syndrome repair.</div></div><div><h3>Methods</h3><div>We performed a multicenter retrospective descriptive study of patients undergoing scimitar syndrome repair with the Lugones procedure. Three variants were used: original, variant A with atrial septum repositioning, and variant B with an interatrial pericardial flap. Primary end points were survival, freedom from reoperation, and freedom from pulmonary venous obstruction. Follow-up was based on clinical assessment and serial echocardiography; computed tomography scan, magnetic resonance imaging/4-dimensional flow magnetic resonance imaging, or cardiac catheterization was obtained when echocardiographic assessment was limited, clinical or imaging findings were equivocal, or complementary anatomic/hemodynamic information was sought.</div></div><div><h3>Results</h3><div>Thirty-eight patients from 11 institutions were included (median age, 5 years; range, 0.7-43). Preoperative scimitar vein stenosis was present in approximately 29%; aortopulmonary collaterals were embolized preoperatively in 24 patients (63%). The original procedure was performed in 28 cases, variant A in 5 cases, and variant B in 5 cases. In-hospital mortality was 0%. Early complications were uncommon (1 postoperative pulmonary venous pathway obstruction due to extrinsic compression; 1 transient diaphragmatic dysfunction). Mean follow-up was 74 months (maximum 13.5 years), with no late deaths, reoperations, recurrent obstruction, or additional late pulmonary venous pathway obstruction. Computed tomography scans consistently demonstrated wide reconstructed pathways; 4-dimensional flow magnetic resonance imaging showed physiological pulmonary venous flow patterns after repair.</div></div><div><h3>Conclusions</h3><div>The Lugones procedure yielded excellent mid-term outcomes with no deaths or reoperations and a very low incidence of postoperative pulmonary venous obstruction.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"39 ","pages":"Article 102571"},"PeriodicalIF":2.4000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS Techniques","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666250726003780","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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Abstract
Objective
The study objective was to report the mid-term outcomes of the Lugones procedure (in situ pericardial rerouting technique) and its variants for scimitar syndrome repair.
Methods
We performed a multicenter retrospective descriptive study of patients undergoing scimitar syndrome repair with the Lugones procedure. Three variants were used: original, variant A with atrial septum repositioning, and variant B with an interatrial pericardial flap. Primary end points were survival, freedom from reoperation, and freedom from pulmonary venous obstruction. Follow-up was based on clinical assessment and serial echocardiography; computed tomography scan, magnetic resonance imaging/4-dimensional flow magnetic resonance imaging, or cardiac catheterization was obtained when echocardiographic assessment was limited, clinical or imaging findings were equivocal, or complementary anatomic/hemodynamic information was sought.
Results
Thirty-eight patients from 11 institutions were included (median age, 5 years; range, 0.7-43). Preoperative scimitar vein stenosis was present in approximately 29%; aortopulmonary collaterals were embolized preoperatively in 24 patients (63%). The original procedure was performed in 28 cases, variant A in 5 cases, and variant B in 5 cases. In-hospital mortality was 0%. Early complications were uncommon (1 postoperative pulmonary venous pathway obstruction due to extrinsic compression; 1 transient diaphragmatic dysfunction). Mean follow-up was 74 months (maximum 13.5 years), with no late deaths, reoperations, recurrent obstruction, or additional late pulmonary venous pathway obstruction. Computed tomography scans consistently demonstrated wide reconstructed pathways; 4-dimensional flow magnetic resonance imaging showed physiological pulmonary venous flow patterns after repair.
Conclusions
The Lugones procedure yielded excellent mid-term outcomes with no deaths or reoperations and a very low incidence of postoperative pulmonary venous obstruction.
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