Single-institution outcomes of surgical repair of infracardiac total anomalous pulmonary venous connection

Shi, Guoyong; Zhu, Fang; Wen, Chen; Qiu, Lisheng; Zhang, Haibo; Zhu, Zhenan; Chen, Huiwen

doi:10.1016/j.jtcvs.2020.06.023

Cited by 25 publications

(28 citation statements)

References 29 publications

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“…Our study found that sutureless technology improved surgical outcomes for patients with infracardiac TAPVC, preoperative PVO, low body weight, or complicated anatomy. These observations are also consistent with previous studies showing that sutureless technology is more suitable for high-risk patients with obstructive, infracardiac or mixed TAPVC (16)(17)(18). However, we cannot definitively conclude that sutureless technology is superior to conventional repair because the difference in overall mortality associated with the two approaches was not found to be statistically significant (Table 6).…”

Section: Mortalitysupporting

confidence: 90%

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

Qiu

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population.Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019.Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time (p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis (p = 0.001), prolonged CPB time (p < 0.001) and increased postoperative CVP (p = 0.007). In particular, mortality was significantly higher (p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques (p = 0.001) and decrease in deep hypothermic circulatory arrest (p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC (p = 0.037), preoperative acidosis (p = 0.001) and prolonged CPB time (p = 0.006).Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery.

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Section: Mortalitysupporting

confidence: 90%

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

Qiu

Liu

et al. 2021

Front. Cardiovasc. Med.

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“…It is also thought to provide a more open egress of blood flow compared to conventional repair techniques by promoting laminar flow. Indeed, data are emerging that support the use of the sutureless technique in primary repair of total anomalous pulmonary veins as it is associated with decreased occurrence of post repair PVS [38][39][40].…”

Section: Intimal Trauma and Hemodynamic Contributionmentioning

confidence: 99%

Pulmonary Vein Stenosis: Incremental Knowledge Gains to Improve Outcomes

Vanderlaan

Caldarone

2021

Children

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“…Using the sutureless technique, a neo-LA is created by anastomosing the LA to pericardium in situ ( Figure 1 ). The sutureless technique not only avoids mechanical stimulus to PVs but also minimizes the distortion of the suture line ( 8 ). In recent years, to prevent potentially postoperative PVO, the sutureless technique, as a prophylactic method, has been adopted for the primary repair of TAPVC ( 1 , 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Sutureless Technique for Primary Total Anomalous Pulmonary Venous Connection Repair: An Updated Meta-Analysis

Zhao

Pan

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAn updated meta-analysis was performed to explore the clinical outcomes following the sutureless repair in patients with total anomalous pulmonary venous connection (TAPVC) and compare outcomes between the sutureless technique and conventional surgery.MethodsA systematic search of PubMed, Ovid-Embase, and Cochrane Library (CENTRAL) for relevant published studies that reported the clinical outcomes of the sutureless technique in children with TAPVC was performed in February 2022. The publication language was restricted to English.ResultsEleven studies were included involving 771 patients in total. Following the sutureless technique, the incidences of postoperative pulmonary venous obstruction (PVO) and reoperations due to PVO were 3.3% [95% confidence interval (CI), 1.3–5.3%] and 1.8% (95% CI, 0.3–3.3%), respectively. The early and late mortality rates were 3.2% (95% CI, 1.0–5.3%) and 2.5% (95% CI, 0.7–4.3%), respectively. Compared with conventional surgery, the sutureless technique significantly reduced the incidences of postoperative PVO [odds ratio (OR), 0.16; 95% CI, 0.08–0.33; P < 0.00001], reoperations due to PVO (OR, 0.25; 95% CI, 0.10–0.63; P = 0.003), and early mortality (OR, 0.40; 95% CI, 0.21–0.79; P = 0.008). However, no significant difference was found between conventional surgery and the sutureless technique concerning late mortality (OR, 0.63; 95% CI, 0.13–3.00; P = 0.58).ConclusionThe sutureless technique is superior to conventional surgery for the primary repair of TAPVC concerning postoperative PVO, reoperations due to PVO, and early mortality. However, the level of evidence is of low quality. Prospective cohort studies or randomized control trials (RCTs) should be performed to evaluate the effectiveness of sutureless techniques for primary TAPVC repair.

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Single-institution outcomes of surgical repair of infracardiac total anomalous pulmonary venous connection

Cited by 25 publications

References 29 publications

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

Pulmonary Vein Stenosis: Incremental Knowledge Gains to Improve Outcomes

Sutureless Technique for Primary Total Anomalous Pulmonary Venous Connection Repair: An Updated Meta-Analysis

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