SINUS NODE DYSFUNCTION FOLLOWING SURGICAL CORRECTION OF SUPRACARDIAC TYPE OF PARTIAL ANOMALOUS PULMONARY VEIN DRAINAGE

To perform the comparative analysis of the double-patch correction of partial anomalous pulmonary vein drainage (PAPVD) in the superior vena cava (SVC) with the Warden procedure, 80 patients (40 patients in each group) were assessed and surgically treated in September 2013 through May 2016. In both study groups, two subgroups were identified. In one of them, the operation was performed using sternotomy and cardioplegia; in the other one, under the conditions of minimally invasive thoracotomy and ventricular fibrillation. The sinus node dysfunction (SND) was the primary endpoint. No early mortality was reported. The average stay on the premises of intensive care unit (ICU) was 1 day in both groups. The duration of mechanical ventilation in the double-patch group (DP) and in the Warden procedure group (WP) was similar, as follows: 4 7 hours (mean: 6 hours) and 3 6 hours (mean: 5 hours), respectively (p=0.13). The SND signs, such as sinus bradycardia, low atrial or nodal rhythm were statistically significantly more prevalent in Group I (27.5%) than in Group II (5%) (p=0.01). Temporary pacing was indicated in the DP group more frequently than in the WP group (17.5% and 2.5% of patients, respectively; p=0.02). In 2 cases (5%), an increased blood flow on the level of SVC with a peak gradient of 6 mm Hg and 7 mm Hg during follow-up echocardiography was revealed. No clinical signs of the superior vena cava syndrome were noted in these patients. No cases of the SVC or pulmonary vein stenosis were revealed after DP procedure. The DP correction of PAPVD in SVC was an independent predictor of SND (OR: 7.37; 95% CI: 1.33 40.6; p=0.02). By the discharge from hospital, SND signs had persisted in 7 patients from the DP group (10%) and in 1 patient (2.5%) from the WP group. The pacemaker implantation was indicated in none of them. All patients were discharged in a good condition; the duration of hospitalization was similar (p=0.81): 9 13 days (mean: 10 days) and 9 12 days (mean: 11 days) in Group I and Group II, respectively. The duration of hospitalization was not associated with the type of access during the procedure (p=0.38). Thus, the surgical treatment of PAPVD in SVC using any technique is beneficial with regard to survival, and is accompanied by few complications irrespective of the type of surgical access. SND occurs more frequently in the case of DP access; however, it is benign and terminates spontaneously. The significant stenosis of pulmonary vein and SVC in the early post-operation period after correction of PAPVD in SVC does not seem a medical problem.

partial anomalous drainage, pulmonary veins, superior vena cava, inter-atrial septum defect, double-patch technique, Warden procedure, sinus node dysfunction

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