Abstract：
BACKGROUND: Several surgical techniques have been proposed to repair right partial anomalous pulmonary venous connection (PAPVC) along with sinus venosus defect (SVD). This study aimed to compare the perioperative data and outcomes of double-patch repair using a minimally invasive approach versus conventional sternotomy in pediatric and adult patients.
METHODS: This retrospective study was conducted on 48 minimally invasive cases and 35 sternotomy cases, undergoing surgery by a single surgeon between July 2002 and August 2020. For all patients, repair was performed using the double-patch technique. In the minimally invasive approach, right mini-thoracotomy was performed with central cannulation for children and with peripheral cannulation for adults. The patients were classified into two pediatric and adult groups, and each group was categorized into minimally invasive and sternotomy approaches. They were followed-up by transthoracic echocardiography and electrocardiography before and early after surgery, 3 and 6 months after surgery, and then annually. The relative data were compared between the two approaches in terms of perioperative findings, postoperative pulmonary vein or superior vena cava (SVC) stenosis, and sinus node dysfunction.
RESULTS: This study included 25 minimally invasive cases and 19 sternotomy cases in the pediatric group (mean age, 4.99 ± 4.28 and 6.10 ± 4.39 years, respectively) and 23 minimally invasive cases and 16 sternotomy cases in the adult group (mean age, 35.73 ± 8.06 and 32.62 ± 9.80 years, respectively). The mean and median follow-ups were 6.31 ± 4.92 years and 6 years (range: 6 month-18 year) in the pediatric group and 6.15 ± 4.53 years and 5 years (range: 6 month-18 year) in the adult group, respectively. The mean chest tube drainage was significantly lower in the minimally invasive pediatric group (p = .03), and the mean blood transfusion volume was significantly lower in the minimally invasive adult group compared to the other groups (p = .03). No stenosis occurred in the pulmonary veins. Mild SVC stenosis occurred in one patient in the minimally invasive pediatric group, with no need for reintervention. All patients had a normal sinus rhythm, except for the mentioned case with a transient, first-degree atrioventricular block, which spontaneously reverted to the normal sinus rhythm.
CONCLUSIONS: The minimally invasive approach can be a safe and practical alternative for the double-patch repair of PAPVC and SVD. It ensures a repair with comparable quality to sternotomy, but with better cosmetic and psychological outcomes.
METHODS: This retrospective study was conducted on 48 minimally invasive cases and 35 sternotomy cases, undergoing surgery by a single surgeon between July 2002 and August 2020. For all patients, repair was performed using the double-patch technique. In the minimally invasive approach, right mini-thoracotomy was performed with central cannulation for children and with peripheral cannulation for adults. The patients were classified into two pediatric and adult groups, and each group was categorized into minimally invasive and sternotomy approaches. They were followed-up by transthoracic echocardiography and electrocardiography before and early after surgery, 3 and 6 months after surgery, and then annually. The relative data were compared between the two approaches in terms of perioperative findings, postoperative pulmonary vein or superior vena cava (SVC) stenosis, and sinus node dysfunction.
RESULTS: This study included 25 minimally invasive cases and 19 sternotomy cases in the pediatric group (mean age, 4.99 ± 4.28 and 6.10 ± 4.39 years, respectively) and 23 minimally invasive cases and 16 sternotomy cases in the adult group (mean age, 35.73 ± 8.06 and 32.62 ± 9.80 years, respectively). The mean and median follow-ups were 6.31 ± 4.92 years and 6 years (range: 6 month-18 year) in the pediatric group and 6.15 ± 4.53 years and 5 years (range: 6 month-18 year) in the adult group, respectively. The mean chest tube drainage was significantly lower in the minimally invasive pediatric group (p = .03), and the mean blood transfusion volume was significantly lower in the minimally invasive adult group compared to the other groups (p = .03). No stenosis occurred in the pulmonary veins. Mild SVC stenosis occurred in one patient in the minimally invasive pediatric group, with no need for reintervention. All patients had a normal sinus rhythm, except for the mentioned case with a transient, first-degree atrioventricular block, which spontaneously reverted to the normal sinus rhythm.
CONCLUSIONS: The minimally invasive approach can be a safe and practical alternative for the double-patch repair of PAPVC and SVD. It ensures a repair with comparable quality to sternotomy, but with better cosmetic and psychological outcomes.
摘要：
背景：已经提出了几种外科技术来修复右部分异常肺静脉连接（PAPVC）以及窦静脉缺损（SVD）。本研究旨在比较儿童和成人患者使用微创方法与常规胸骨切开术进行双补片修复的围手术期数据和结果。
方法：这项回顾性研究是对48例微创病例和35例胸骨切开术进行的，在2002年7月至2020年8月期间由一名外科医生进行手术。对于所有患者来说，使用双补片技术进行修复.在微创方法中，右侧微型开胸手术对儿童进行中央插管,对成人进行外周插管.患者分为儿童组和成人组，每组分为微创和胸骨切开术。术前及术后早期经胸超声心动图和心电图随访,手术后3个月和6个月，然后每年。就围手术期结果而言，比较了两种方法之间的相关数据，术后肺静脉或上腔静脉（SVC）狭窄，和窦房结功能障碍.
结果：本研究包括小儿组的25例微创病例和19例胸骨切开术（平均年龄，4.99±4.28和6.10±4.39年，分别）和成人组中23例微创病例和16例胸骨切开术(平均年龄，35.73±8.06和32.62±9.80年，分别)。儿童组的平均和中位随访时间为6.31±4.92年和6年（范围：6个月-18年），成人组为6.15±4.53年和5年（范围：6个月-18年），分别。微创儿科组的平均胸腔引流率显着较低（p=0.03），与其他组相比，微创成人组的平均输血量明显更低（p=0.03）。肺静脉无狭窄发生。微创小儿组1例患者发生轻度SVC狭窄,不需要再干预。所有患者窦性心律正常,除了上面提到的有瞬变的情况，一级房室传导阻滞,自发恢复到正常的窦性心律。
结论：对于PAPVC和SVD的双补片修复，微创方法可能是一种安全实用的替代方法。它确保了与胸骨切开术相当质量的修复，但是美容和心理效果更好。
方法：这项回顾性研究是对48例微创病例和35例胸骨切开术进行的，在2002年7月至2020年8月期间由一名外科医生进行手术。对于所有患者来说，使用双补片技术进行修复.在微创方法中，右侧微型开胸手术对儿童进行中央插管,对成人进行外周插管.患者分为儿童组和成人组，每组分为微创和胸骨切开术。术前及术后早期经胸超声心动图和心电图随访,手术后3个月和6个月，然后每年。就围手术期结果而言，比较了两种方法之间的相关数据，术后肺静脉或上腔静脉（SVC）狭窄，和窦房结功能障碍.
结果：本研究包括小儿组的25例微创病例和19例胸骨切开术（平均年龄，4.99±4.28和6.10±4.39年，分别）和成人组中23例微创病例和16例胸骨切开术(平均年龄，35.73±8.06和32.62±9.80年，分别)。儿童组的平均和中位随访时间为6.31±4.92年和6年（范围：6个月-18年），成人组为6.15±4.53年和5年（范围：6个月-18年），分别。微创儿科组的平均胸腔引流率显着较低（p=0.03），与其他组相比，微创成人组的平均输血量明显更低（p=0.03）。肺静脉无狭窄发生。微创小儿组1例患者发生轻度SVC狭窄,不需要再干预。所有患者窦性心律正常,除了上面提到的有瞬变的情况，一级房室传导阻滞,自发恢复到正常的窦性心律。
结论：对于PAPVC和SVD的双补片修复，微创方法可能是一种安全实用的替代方法。它确保了与胸骨切开术相当质量的修复，但是美容和心理效果更好。
