Transcatheter Versus Surgical Correction of Superior Sinus Venosus Defects: Comparison of the Outcomes and Late Complications.

Transcatheter correction (TC) of sinus venosus defects (SVD) is an emerging alternative to surgical correction (SC). Superior vena caval (SVC) or right upper pulmonary vein (RUPV) stenosis and sick sinus syndrome are complications of SC. This retrospective study analyzed the outcomes of SC and TC in the last 14 years. TC was considered in children only when their parents refused surgery and accepted the follow-up imaging protocol. Follow-up Transesophageal echocardiography (TEE), computed tomography (CT), or magnetic resonance (MR) were performed after all TC to identify residual shunt, venous obstruction, and stent thrombosis. Follow-up after SC was limited to transthoracic echocardiography, unless patients consented for TEE or CT. The study compared 148 SC and 127 TC between 2011 and 2024. While SC group were significantly younger, TC groups were more symptomatic and more often had pulmonary hypertension. Comorbidities occurred in 14% of SC and 26% of TC. Pre-procedural CT/MR performed in 73.2% of TC identified additional pulmonary veins in 23.6%; advanced imaging was rarely performed before SC and identified additional veins in 5.3% only. Surgical and bypass times in SC far exceeded procedural and fluoroscopic times in TC. Hospital and intensive care stay were significantly lower in TC. Three procedural failures in TC (2.4%) due to stent embolization occurred in early learning curve. Acute complications in 18.1% of TC and 9.1% of SC were successfully managed. Late complications occurred in 23.8% of SC (SVC or RUPV stenosis, residual shunt, and sinus nodal dysfunction) and 12% of TC (stent thrombosis or residual shunt). Reinterventions were required in 4.6% after SC and 1.6% after TC. SC and TC had comparable outcomes, complications, and reinterventions. TC is an attractive option in adults especially with comorbidities and pulmonary hypertension. Continued surveillance is mandatory to determine the long-term outcomes.