Preserving Pathways: Strategies for Left Superior Vena Cava Management in Pediatric Cardiac Surgery

Background

Persistent left superior vena cava (LSVC) is a common congenital anomaly requiring operative management when it causes significant right-to-left shunting or during heart transplantation. Comparative patency of various LSVC repatriation methods to the right side of the heart has not been systematically studied.

Methods

This is a single-institution, retrospective review of patients undergoing surgical management of LSVC from 2013 to 2023. Patients were grouped on the basis of the LSVC to right atrium path: coronary sinus (CS) group with LSVC-CS anastomosis; systemic vein (SV) group with LSVC drainage through donor superior vena cava, right atrial appendage, or innominate vein; or atrial baffle (AB) group. Our primary objective is LSVC patency rate in each group.

Results

Twenty-two patients with a median age of 27 months met inclusion criteria; 4 patients were in the CS group, 9 in the SV group, and 9 in the AB group. At the time of collection, 3 (75%) patients in the CS group, 3 (33%) in the SV group, and 9 (100%) in the AB group showed LSVC patency. All patients demonstrating patency in CS and SV groups were older than 2 years, whereas all patients with occlusion (except for a 35-year-old patient) were younger than 2 years.

Conclusions

Of the methods redirecting LSVC to the right atrium, patency may be best preserved with an undistorted LSVC reunited with a retained CS or redirected by an intracardiac baffle compared with methods that displace the LSVC. Older patients with higher weight may have better patency rates with LSVC reconstruction.