Ignacio Lugones, Antonio Gonzalez Calle, Ramón Pérez-Caballero, Giuseppe Pelella, Virginie Fouilloux, Inés A. Martínez, Veronica Laudani, Ashish Katewa, Héctor S. Díliz-Nava, Javier H. López Terrazas, Alexis J. Palacios Macedo-Quenot, Juan Miguel Gil-Jaurena, Daniel A. Klinger, Benjamin Chiostri, Andrés Rosso, Norberto Berber, María Sol De Los Santos, Natalia Troncoso, Victoria E. Zerpa Pacheco, Fernanda Biancolini, Julio Biancolini, Julieta Rancati, Alejandro Jorajuria, Ayush Balaji, Héctor Graneros, Ignacio Juaneda, Christian Kreutzer, James D. St. Louis
Hospital General de Niños “Dr Pedro de Elizalde”. Long Island University. Hospital Universitario Virgen del Rocío. Hospital General Universitario Gregorio Marañón. Leeds Teaching Hospitals NHS Trust, Leeds. Hopitaux de Marseille. Centro Cardiologico Pediatrico del Mediterraneo. Amrita Hospital. Instituto Nacional de Pediatría. Hospital Universitario Austral. Hospital de Niños “Dr Ricardo Gutiérrez”. Hospital El Cruce. Hull York Medical School. Universidad Nacional de La Rioja. Hospital Privado de Córdoba. Augusta University.
Argentina, United States, Spain, United Kingdom, France, Italy, India and Mexico
Journal of Thoracic and Cardiovascular Surgery Techniques
JTCVS Tech 2026; 39:
DOI: 10.1016/j.xjtc.2026.102571
Abstract
Objective: The study objective was to report the mid-term outcomes of the Lugones procedure (in situ pericardial rerouting technique) and its variants for scimitar syndrome repair.
Methods: We performed a multicenter retrospective descriptive study of patients undergoing scimitar syndrome repair with the Lugones procedure. Three variants were used: original, variant A with atrial septum repositioning, and variant B with an interatrial pericardial flap. Primary end points were survival, freedom from reoperation, and freedom from pulmonary venous obstruction. Follow-up was based on clinical assessment and serial echocardiography; computed tomography scan, magnetic resonance imaging/4-dimensional flow magnetic resonance imaging, or cardiac catheterization was obtained when echocardiographic assessment was limited, clinical or imaging findings were equivocal, or complementary anatomic/hemodynamic information was sought.
Results: Thirty-eight patients from 11 institutions were included (median age, 5 years; range, 0.7-43). Preoperative scimitar vein stenosis was present in approximately 29%; aortopulmonary collaterals were embolized preoperatively in 24 patients (63%). The original procedure was performed in 28 cases, variant A in 5 cases, and variant B in 5 cases. In-hospital mortality was 0%. Early complications were uncommon (1 postoperative pulmonary venous pathway obstruction due to extrinsic compression; 1 transient diaphragmatic dysfunction). Mean follow-up was 74 months (maximum 13.5 years), with no late deaths, reoperations, recurrent obstruction, or additional late pulmonary venous pathway obstruction. Computed tomography scans consistently demonstrated wide reconstructed pathways; 4-dimensional flow magnetic resonance imaging showed physiological pulmonary venous flow patterns after repair.
Conclusions: The Lugones procedure yielded excellent mid-term outcomes with no deaths or reoperations and a very low incidence of postoperative pulmonary venous obstruction.
Category
Stenosis or Obstruction of Pulmonary Veins Following Surgical Repair of Anomalous Pulmonary Venous Connections
Incidence or Prevalence of Disease
Surgical Interventions to Prevent or Limit Disease Associated with Repair of Anomalous Pulmonary Venous Connections or Heart Transplantation
Year of Publication: 2026
Age Focus: Pediatric or Adult
Article Type: Retrospective Observational Cohort Studies (>10 patients)
Article Access: Free PDF File or Full Text Article Available Through PubMed or DOI: Yes