Management algorithm for pulmonary vein stenosis: An evaluation of available surgical data

Background: Pulmonary vein stenosis (PVS) is a rare complication after radiofrequency ablation for patients with atrial fibrillation. However, the impact of a high-grade stenosis on a patient's hemodynamic situation and quality of life can be severe. Percutaneous balloon angioplasty or stent implantation are interventional treatment options for severe and symptomatic PVS. Owing to significant postinterventional restenosis rates, the management of PVS remains challenging, and the investigation of other options, such as surgical correction, is warranted. Objectives: In this study, a structured literature review on surgical treatment strategies for PVS was performed. Based on these findings and multidisciplinary clinical experience, we developed a pragmatic management algorithm to guide individualized treatment decisions for patients with severe or recurrent PVS. Methods: A literature review was conducted using PubMed, following the population, intervention, comparison, and outcome framework. A treatment algorithm was designed as a decision flowchart. Results: The literature search identified 7 publications on cardiothoracic surgical techniques for the treatment of PVS, describing 11 cases. Although the most common surgical approach was pericardial patchplasty, sutureless techniques and a combination of operations, including endarterectomy, bypass, widening plasty after stent implantation, suturing the vein directly to the left auricle, or the use of pulmonary homograft tissue, were also described in the literature. Conclusion: Managing PVS is challenging, especially in cases of restenosis. These patients should be discussed in a multidisciplinary setting, including cardiology, radiology, and thoracic surgery. We propose a treatment algorithm that may aid in individual decision making and serve as a starting point for future discussions.