Surgical pulmonary vein repair resulted in similar overall mortality compared to catheter-based intervention alone (50% vs 30%, p=0.294), with 92% of surgical patients requiring subsequent reintervention.
Cohort (n=56)
No
Does surgical pulmonary vein repair compared to catheter-based intervention alone improve survival or reduce the need for reintervention in children with biventricular physiology and pulmonary vein stenosis?
In pediatric patients with pulmonary vein stenosis, both surgical and catheter-based interventions are associated with high rates of reintervention, with no significant difference in overall mortality between the two approaches.
Absolute Event Rate: 50% vs 30%
p-value: p=0.294
Pulmonary vein stenosis (PVS) is a rare but serious condition in children, often requiring surgical or catheter-based interventions. The initial optimal treatment strategy remains unclear due to disease complexity, progression, and high rates of recurrence. In this retrospective, single-center study, we identified children with primary or secondary PVS from a cardiac catheterization and surgical database between 2015 and 2023. Patients with single ventricle physiology were excluded. Demographics and outcomes were compared between patients who underwent catheter-based intervention only and those who underwent at least one surgical pulmonary vein repair, with or without subsequent catheter-based reintervention. Reintervention following surgical repair was assessed using Kaplan-Meier analysis. Among 56 children with biventricular physiology and PVS (33 males, 59%), 16 (29%) underwent at least one surgical repair at a median age of 9 months (IQR 4–20), while 40 (71%) were managed with catheter-based interventions alone. Surgical repair was more frequently performed in patients with bilateral or complex disease, particularly those without prematurity or with coexisting congenital heart defects requiring open-heart surgery. Over time, catheter-based approaches became increasingly preferred. Overall, 92% of surgical patients required reintervention, most within the first year. Mortality did not significantly differ between groups (p = 0.294). In the surgical group, elevated right ventricular/systemic systolic pressure ratio (HR: 1.25, p = 0.048) and the presence of scimitar syndrome (HR: 8.25, p = 0.011) were associated with increased mortality. Surgical pulmonary vein repair remains an important option, particularly in cases where catheter-based intervention is not feasible due to anatomical challenges or when multiple pulmonary veins are severely affected. However, recurrent pulmonary vein re-intervention is common, regardless of whether the initial approach was surgical or catheter-based.
Takajo et al. (Fri,) conducted a cohort in Pediatric Pulmonary Vein Stenosis (n=56). Surgical pulmonary vein repair vs. Catheter-based intervention only was evaluated on Mortality (p=0.294). Surgical pulmonary vein repair resulted in similar overall mortality compared to catheter-based intervention alone (50% vs 30%, p=0.294), with 92% of surgical patients requiring subsequent reintervention.