Clinical Report: Comparative Analysis of Postoperative Arrhythmias Following Rotational Z-Flap Versus Patch Repair Techniques for Sinus Venosus Atrial Septal Defects

Overview

This study compares postoperative arrhythmias following two surgical techniques for sinus venosus atrial septal defects (SVASD). The rotational Z-flap technique demonstrated shorter operative times but a higher incidence of junctional rhythms compared to the conventional patch repair.

Background

Sinus venosus atrial septal defects (SVASD) are often associated with partial anomalous pulmonary venous return (PAPVR) and require surgical intervention. While surgical correction has low mortality, postoperative arrhythmias remain a significant concern due to the proximity of the sinus node. Understanding the outcomes of different surgical techniques is crucial for optimizing patient care and minimizing complications.

Data Highlights

Key Findings

• The Z-flap technique resulted in significantly shorter total operative, bypass, and cross-clamp times compared to the baffle technique.
• Postoperative rhythm disturbances were observed in 54.5% of patients, with right bundle branch block being the most common (40.1%).
• The Z-flap group had a significantly higher incidence of sinoatrial block with junctional rhythm (17.5% vs. 4.3%; p = 0.035).
• No patients required permanent pacemaker implantation post-surgery.
• No significant differences were found in residual shunts or superior vena cava stenosis between the two techniques.

Clinical Implications

Surgeons should consider the trade-offs between surgical efficiency and the risk of postoperative arrhythmias when selecting a technique for SVASD repair. Continuous monitoring for rhythm disturbances postoperatively is essential, particularly for patients undergoing the Z-flap technique.

Conclusion

Both the Z-flap and baffle techniques are effective for SVASD correction, each with unique advantages and risks. The choice of technique should be tailored to individual patient anatomy and risk factors.

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2. Pediatric Cardiology, 2021 -- Repair of Partial Anomalous Pulmonary Venous Connection: Tailored Strategies and Clinical Outcomes
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4. Hub, 2025 -- 2025 Guideline for the Management of Adults With Congenital Heart Disease
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8. Hub - 2025 Guideline for the Management of Adults With Congenital Heart Disease - Professional Heart Daily | American Heart Association
9. Outcomes Following Surgical Repair of Sinus Venosus Atrial Septal Defects: A Systematic Review and Meta‐Analysis - PMC
10. Frontiers | Same-same, but different? Postoperative rhythm disturbances and other analysis after rotational Z-flap vs. patch repair of sinus venosus atrial defects