Primary sutureless repair for “simple” total anomalous pulmonary venous connection: Midterm results in a single institution

Abstract

The sutureless repair group had proportionally more infracardiac total anomalous pulmonary venous connection and a higher rate of decline in postoperative right ventricular systolic pressure. Despite increased preoperative risk, no difference was observed in primary outcomes of death and reoperation in the conventional repair group.

Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection

“…Inspired by the relatively satisfactory outcomes of sutureless repair, some surgeons have begun to utilize this technique for primary pulmonary vein anomalies 2,9,12 . However, the midterm results have not shown significant differences in death and reoperation rates between sutureless and conventional repair 9,12 . In 2007, some surgeons in our department started to use the sutureless technique for primary TAPVC repair, whereas others continued to use the conventional technique.…”

“…However, our suturing method was not as same as that described by Yanagawa et al 12 in "Primary sutureless repair for 'simple' total anomalous pulmonary venous connection: Midterm results in a single institution". We preferred to use free edge-to-free edge stitches, especially at the apex of the triangle zone between two individual pulmonary incisions, and one stitch should suspend the pulmonary venous wall to prevent it from dropping into the lumen.…”

Repair Type Influences Mode of Pulmonary Vein Stenosis in Total Anomalous Pulmonary Venous Drainage

“…The SR was achieved by direct anastomosis between the PV confluence and the LA free edge. A detailed description of SL techniques has been previously reported [4,9,10]. Briefly, cardiopulmonary bypass is instituted with aortic and bicaval cannulation.…”

“…All postoperative echocardiographic reports were reviewed, and pulmonary veins score (PVS) was calculated at each time point as previously reported [8,9]. A value of 0 was assigned if the mean gradient was less than 2 mm Hg, 1 if it was between 2 and 6.9 mm Hg, 2 if it was 7 mm Hg or greater, and 3 if the vein was occluded.…”

“…We initially started using SL as primary repair technique for TAPVD subtypes at higher risk of postrepair PVO, such as infracardiac and mixed, or for preoperative PVO [8]. Based on encouraging initial experiences, the SL has become the primary technique adopted for most of the TAPVD forms [9]. The theoretical advantage of SL repair is to lateralize the suture line away from the confluence edge of the PVs, minimizing the mechanical stimuli for developing obstruction (Fig 1A).…”