MODIFIED SUPERIOR APPROACH FOR REPAIR OF SUPRACARDIAC AND MIXED TOTALANOMALOUS PULMONARY VENOUS DRAINAGE

Background. The main goal in the surgical repair of total anomalous pu lmonary venous drainage is to reestablish a wide patent connection bet ween the common pulmonary vein and the left atrium. Several techniques have been proposed for achieving this objective, each of which has ad vantages and disadvantages. The superior approach between the superior vena cava and the ascending aorta was introduced in 1976 for the repa ir of supracardiac forms of total anomalous pulmonary venous drainage, but it often provides a less than optimum exposure, particularly in t iny infants. We proposed a modification of this approach that includes division of the ascending aorta and offers excellent exposure. Method s. Seventeen patients (15 neonates and 2 infants) with supracardiac to tal anomalous pulmonary venous drainage (n = 13) or mixed forms of tot al anomalous pulmonary venous drainage (n = 4) underwent surgical repa ir with the use of the modified superior approach. Circulatory arrest was not required in 10 patients and the mean cross-clamp time was 32.5 +/- 13.8 minutes. Results. There was 1 postoperative death resulting from intractable pulmonary hypertension in a compromised infant who wa s referred to our unit receiving extracorporeal membrane oxygenation. One patient with common hypoplasia underwent reoperation twice at 2 mo nths and then 3 months after the first procedure. All the other patien ts had a smooth postoperative course, and midterm evaluation showed a widely patent anastomosis between the common vein and the left atrium. Conclusions. The modified superior approach for the repair of supraca rdiac total anomalous pulmonary venous drainage can be useful to enhan ce exposure during surgical repair and may contribute to improved pati ent outcome. (C) 1998 by The Society of Thoracic Surgeons.