Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis

Abstract

The risk factors for superior vena cava (SVC) obstruction after pediatric orthotopic heart transplantation (OHT) have not been identified. This study tested the hypothesis that pretransplant superior cavopulmonary anastomosis (CPA) predisposes patients to SVC obstruction. A retrospective review of file Pediatric Cardiac Care Consortium registry from 1982 through 2007 was performed. Previous CPA, other cardiac surgeries, gender, age at transplantation, and weight at transplantation were assessed for the risk of developing SVC obstruction. Death, subsequent OHT, or reoperation involving the SVC were treated as competing risks. Of the 894 pediatric OHT patients identified, 3.1% (n = 28) developed SVC obstruction during median follow-up of 1.0 year (range: 0 to 19.5 years). Among patients who developed SVC obstruction, 32% (n = 9) had pretransplant CPA. SVC surgery before OHT was associated with posttransplant development of SVC obstruction (p <0.001) after adjustment for gender, age, and weight at OHT and year of OHT. Patients with previous CPA had increased risk for SVC obstruction compared with patients with no history of previous cardiac surgery (hazard ratio 10.6,95% confidence interval: 3.5 to 31.7) and to patients with history of non-CPA cardiac surgery (hazard ratio 4.7,95% confidence interval: 1.8 to 12.5). In conclusion, previous CPA is a significant risk factor for the development of post—heart transplant SVC obstruction. Published by Elsevier Inc. (Am J Cardiol 2013;112:286–291)

Transcatheter stenting of superior vena cava obstruction after pediatric heart transplantation: A single‐center experience assessing risk factors and outcomes

“…Our 3.4% rate of stent implantation among OHTs is similar to the 1%‐5% rate published in other studies . Patients who required SVC stent implantation were of a younger age and smaller weight compared to those who did not require SVC stenting in our study population.…”

“…Prior SPCA poses a risk for future SVC obstruction. Similar to the findings of Aldoss et al in their analysis from the Pediatric Cardiac Care Consortium, this risk was reflected as a significant difference between patients who received SVC stents compared to those who did not. In addition, operative reports further described surgical augmentation of the SVC performed at the time of transplant in two patients who ultimately required SVC stent implantation.…”

“…Patients who required SVC stent implantation were of a younger age and smaller weight compared to those who did not require SVC stenting in our study population. Other studies have alluded to the potential of this association with smaller weight, while none have shown statistical association . Our data suggest that age and weight may be thought of as surrogates for vena caval size, contributing to a more technically challenging caval anastomosis.…”

“…Pediatric patients may be at greater risk for SVC obstruction due to smaller absolute vessel size, donor‐recipient size discrepancy, type of surgical anastomosis, and complex congenital cardiac anatomy. While prior studies address some associations, several important risk factors such as bicaval anastomosis, lower recipient weight, and donor‐recipient size discrepancy remain implied rather than statistically examined, either due to lack of patient data from the inherent limitations of registry‐based studies or small sample size precluding analysis …”

Pediatric superior vena cava syndrome: An evidence‐based systematic review of the literature

“…There are a small number of retrospective cohort studies but most are not generalizable since they include both adults and children in the same cohort 4,6,9,10,[12][13][14][15][16][17] or they focus on a specific subgroup of SVCS patients, 2,3,5,11,18,19 as outlined in Supplementary Table S5. One of the studies, conducted by Tzifa et al, was a single-center retrospective cohort study that examined the characteristics of cardiac versus noncardiac SVCS.…”