Outcomes of total anomalous pulmonary venous drainage repair in neonates and the impact of pulmonary hypertension on survival

Surgical repair of neonatal total anomalous pulmonary venous connection: A single institutional experience with 241 cases

“…These patients usually present with moderate/mild hypoxemia; tertiary care potentially produces the clinical benefit and helps to bridge the time to surgery. This is partially in line with the large experience on surgical care for neonatal patients with TAPVC (sample size: 175) from the Melbourne group, 9 in which less than one half of the patients (43%, 49/115) with preoperative PVO underwent emergency operation. Plausibly, it can be speculated that a portion of the “obstructed” patients can be triaged to elective surgery if appropriately managed.…”

“…It is noteworthy that the access to DPC conferred an approximately 4-fold decrease in death, particularly resulting in the postoperative 1-year mortality of 3.7% that was remarkably lower than previously published data. 1 , 6 , 7 , 8 , 9 Therapeutic plan associated with serial lactate monitoring in DPC group is related to the improved lactate clearance, which is a possible explanation for the better survival, as emerging evidence has shown that lactic acidosis can decrease cardiac contractility, tissue perfusion, and sensitize the myocardium to cardiac arrhythmias, and it is associated with increased mortality in pediatric patients with cardiac disease. 17 , 27 Several specific factors of the CICU care model are responsible for the improvement in the preoperative health: first, personnel has sufficient training in congenital heart disease; second, the team-based multidisciplinary approach enables optimal decision-making in terms of preoperative planning and surgical timing; third, development and implementation of a standardized protocol can allow for rapid patient risk-stratification and timely targeted therapies (therapeutic plan associated with the monitor), all of which cater to the preoperative needs of these vulnerable newborns better than the NICU/PICU ( Figure 5 ).…”

“…Surgery for total anomalous pulmonary venous connection (TAPVC) in neonates remains challenging and is classified as a high-complexity and high-risk procedure based on several universally accepted risk score tools. 1 , 2 , 3 Despite the relentless efforts in pursuit of operative refinements 4 , 5 and better risk stratification, 6 , 7 outcome improvements have not been observed in this subpopulation, 8 , 9 driving the unmet need for identifying relative modifiable risk/protective factors for continued improvement.…”

ECMO support for postoperative Total anomalous pulmonary venous connection: A single-center retrospective study

“…Postoperative pulmonary hypertension (PHT) crisis was recorded by staff when there was acute rise in pulmonary arterial pressure (PAP) accompanied by an apparent reduction in cardiac output, as manifested by a significant drop in systemic arterial pressure or when there was strong clinical suspicion due to acute drop in systemic arterial pressure with high central venous pressure and decreased lung compliance in patients without a pulmonary arterial line. [11] Operative Technique…”