Caval translocation as a surgical strategy for patients with congenital heart disease and bilateral superior vena cava.

Objective: The presence of bilateral superior vena cava (SVC) may complicate biventricular or single-ventricle pathway surgery. Translocation of an SVC to create a neoinnominate vein may simplify subsequent procedures. Methods: Fourteen patients received an SVC translocation. The longer SVC was translocated, facilitated by complete mobilization of both SVCs, including division of azygos or hemiazygos, and bilateral mammary veins, which increased length and reduced tension on the SVC-SVC anastomosis. Results: Translocation was achieved in 6 patients with commonly corrected defects, in 5 patients to aid in biventricular conversions, and in 3 patients in conjunction with a cavopulmonary anastomosis. At a median follow-up of 1.3 years (range, 2 weeks to 7.1 years), there were no translocation-related deaths or evidence of impaired superior systemic venous return. Conclusions: For patients with bilateral SVCs, translocation is a valuable addition to the armamentarium of strategies and holds promise for facilitating biventricular repair. Moreover, for patients requiring cavopulmonary anastomosis, a translocation enables a single cavopulmonary connection, and future studies may prove this strategy to be optimal over the traditional bilateral cavopulmonary connection.