Re-intervention for Superior Vena Cava Obstruction after Heart Transplant


Children undergoing orthotopic heart transplantation (OHT) may require complex reconstruction of superior vena cava (SVC) anomalies. SVC anatomy and mode of reconstruction are potential risk factors for SVC obstruction.


Retrospective single-center review of patients undergoing initial OHT between 1/1/1990-7/1/2021. “Simple” SVC anatomy included a single right SVC to the right atrium or bilateral SVCs with a left SVC to an intact coronary sinus, without prior superior cavopulmonary connection. Presence of anomalous SVC anatomy, superior cavopulmonary connection, and/or previous atrial switch operation defined “complex” anatomy. Reconstructive strategies included atrial anastomosis, direct SVC-to-SVC anastomosis, and augmented SVC anastomosis using innominate vein, patch, cavopulmonary connection, or interposition graft. Primary outcome was re-intervention for SVC obstruction.


Of 288 patients, pre-transplant diagnoses included congenital heart disease (n=155, 54%), cardiomyopathy (n=125, 43%), and other (n=8, 3%). The majority (n=208, 72%) had simple SVC anatomy compared to complex SVC anatomy (80, 28%). Re-intervention for SVC obstruction occurred in 15/80 (19%) with complex anatomy, and 1/208 (0.5%) with simple anatomy (p=0.0001). Re-intervention was more common when innominate vein or a patch was used (9/25, 36%), compared to an interposition graft (1/7, 14%), or direct anastomosis (6/82, 7%) (χ2=13.1, p=0.001). Most re-interventions occurred within 30 days of OHT (14/16, 88%).


Patients with complex SVC anatomy have a higher rate of re-intervention for SVC obstruction after OHT compared to those with simple SVC anatomy. In cases of complex SVC anatomy, interposition grafts may be associated with less re-intervention compared to complex reconstructions using donor tissue.

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