Risk factors associated with post-transplant superior caval vein stenosis in paediatric heart transplantation

Abstract

Superior caval vein stenosis is a known complication following paediatric heart transplantation. Herein, we sought to assess the incidence of superior caval vein stenosis and need for intervention in a single centre paediatric heart transplantation programme. A retrospective review was performed to identify variables associated with superior caval vein stenosis and need for intervention. Patients were identified based on angiographic and echocardiographic signs of superior caval vein stenosis. Of 204 paediatric heart transplantation recipients, 49 (24.0%) had evidence of superior caval vein stenosis with no need for catheter intervention and 12 (5.9%) had superior caval vein stenosis requiring catheter intervention. Overall, patients with superior caval vein stenosis with and without intervention had more cavopulmonary anastomosis (41.7%; 20.4%), pre-transplant superior caval vein procedures (41.7%; 28.6%), and bicaval approach (100.0%; 98.0%), compared to the group with no stenosis (11.9% and p = 0.015, 12.6% and p = 0.004, 73.4% and p < 0.001, respectively). Smaller recipients and donors were more likely to need intervention. Intervention was also seen more frequently in recipients who were younger at diagnosis (4.7 years) compared to non-intervention (13.3 years; p = 0.040). Re-intervention was required in 16.7% patients (n = 2) and was not associated with any complications.

Surgical Results of the Superior Vena Cava Intimal Layer-Only Suture Technique in Heart Transplantation

“…Among those complications in the bicaval technique, several risk factors for SVC stenosis were introduced, including younger age at transplantation, donor-recipient size mismatch, and previous SVC anastomosis history [ 5 , 9 - 11 ]. Younger patients showed an SVC stenosis incidence of approximately 3.1% [ 12 ].…”

“…However, these modified surgical techniques have potential SVC stenosis problems because a thickened SVC wall is still included during SVC anastomosis. The thickened SVC walls may function as a cause of SVC stenosis, especially in cases of donor-recipient size discrepancies or with younger recipients [ 5 , 9 - 12 ]. However, the intimal layer-only technique has an advantage in cases of size discrepancy or younger age due to the lack of involvement of the medial and adventitial layers.…”

“…However, we often encounter SVC wall thickness differences between donor and recipient hearts due to prolonged indwelling catheter times. This makes it difficult to anastomose the vessels and may be a risk factor for SVC stenosis [ 5 ]. For these reasons, we performed intima-only sutures during SVC anastomosis to avoid SVC stenosis and simplify anastomosis.…”