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. 2025 Sep 19:34:148-160.
doi: 10.1016/j.xjtc.2025.08.026. eCollection 2025 Dec.

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

Hani K Najm  1 , Samuel M Hoenig  1   2 , Justin Robinson  1 , Rashed Mahboubi  1 , Kaoutar Farahi  1 , John P Costello 3rd  1 , Munir Ahmad  1 , Brittaney A Potz  1 , Jaehyun Lee  3 , Tara Karamlou  4
Affiliations

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

Hani K Najm et al. JTCVS Tech. .

Abstract

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.

Keywords: bilateral superior vena cava; caval translocation; heterotaxy; neoinnominate vein.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Caval translocation restoring “normal” anatomy for cavopulmonary anastomoses.
Figure 1
Figure 1
Surgical strategies for bilateral SVCs. A, LSVC Translocation in conjunction with complete tetralogy of Fallot repair. B/C, RSVC translocation anterior and posterior to the aorta as part of the ventricular switch technique. D, LSVC translocation as part of a cavopulmonary anastomosis. E, Bilateral cavopulmonary anastomosis without translocation. Red arrow indicates saturated blood, blue arrow indicates not saturated blood. SVC, Superior vena cava; LSVC, left superior vena cava; RSVC, right superior vena cava.
Figure 2
Figure 2
Surgeon's view of (A) elaborate mobilization of RSVC, (B) division of hemiazygos vein from LSVC and visualization of a small native innominate vein, and (C) completed RSVC translocation in the superior region of the LSVC just adjacent to small native innominate vein (patient 10). RSVC, Right superior vena cava; LSVC, left superior vena cava.
Figure 3
Figure 3
Completed SVC translocations at the time of cavopulmonary anastomosis. A, Patient 13. B, Patient 14. SVC, Superior vena cava.
Figure 4
Figure 4
Catheterization after bilateral cavopulmonary anastomosis. A-B, patient 17, mild narrowing in medial right pulmonary artery without obstructed flow. C-D, patient 18, moderate narrowing of medial right pulmonary artery. E-F, Patient 21, occlusion of central left pulmonary artery. Ground glass opacities left lower lung (F) consistent with bubble study (G) for arteriovenous malformations.
Figure E1
Figure E1
LSVC Translocation posterior to the aorta (patient 12). A, Elaborate LSVC mobilized with a cannula inserted directly into the LSVC. B, Cannula is used to thread LSVC posterior to the aorta before RSVC anastomosis with 7-0 PROLENE. LSVC, Left superior vena cava; RSVC, right superior vena cava.
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