Management Algorithm for Pulmonary Vein Stenosis: An Evaluation of Available Surgical Data

AbstractBackground Pulmonary vein stenosis (PVS) is a rare complication following radiofrequency ablation for patients with atrial fibrillation. However, the impact of a high-grade stenosis on a patient's haemodynamic situation and quality of life can be severe. Percutaneous balloon angioplasty (BA) or stent implantation are interventional treatment options for severe and symptomatic PVS. Due to significant postinterventional restenosis rates, the management of PVS remains challenging, and the investigation of other options, like surgical correction, is warranted. Objectives In this study, a structured literature review on surgical treatment strategies for PVS was performed. Based on these findings and multidisciplinary clinical experience, we developed a pragmatic management algorithm to guide individualized treatment decisions for patients with severe or recurrent PVS. Methods A literature review was conducted using PubMed, following the PICO framework. A treatment algorithm was designed as a decision flowchart. Results The literature search identified seven publications on cardiothoracic surgical techniques for the treatment of PVS, describing 11 cases. While the most common surgical approach was pericardial patch plasty, sutureless techniques and a combination of operations, including endarterectomy, bypass, widening plasty after stent implantation, suturing the vein directly to the left auricle, or the use of pulmonary homograft tissue, were also described in the literature. Conclusion Managing PVS is challenging, especially in cases of restenosis. These patients should be discussed in a multidisciplinary setting, including cardiology, radiology, and thoracic surgery. We propose a treatment algorithm that may aid in individual decision-making and serve as a starting point for future discussions.