ObjectiveTo analyze the surgical results of patients with supracardiac total anomalous pulmonary venous connection (TAPVC) in a single pediatric cardiac center.MethodsA retrospective study was conducted on 98 pediatric patients with supracardiac TAPVC receiving surgical repair from 2014 to 2019 in our center. There were 64 males and 34 females with a median surgical age of 3.0 (1.5, 7.0) months and a median weight of 5.0 (4.0, 6.0) kg. Twenty-three (23.5%) patients had preoperative pulmonary vein obstruction. Ninety-two (93.9%) patients received conventional surgical repair, while six (6.1%) patients were treated with the sutureless technique. The Cox regression model was used to analyze the data.ResultsThe median follow-up time was 26.50 (5.75, 44.25) months. There were 9 (9.2%) deaths. Lower weight at the time of repair (P=0.013) and prolonged cardiopulmonary bypass time (P=0.007) were associated with mortality. Postoperative pulmonary vein obstruction was observed in 8 (8.2%) patients. Associated risk factors for postoperative pulmonary vein obstruction included lower weight at the time of repair (P=0.042) and prolonged cardiopulmonary bypass time (P=0.002).ConclusionSurgical repair of supracardiac TAPVC has achieved satisfactory results in our center. Risk factors such as lower weight at the time of repair and prolonged cardiopulmonary bypass time are associated with a poor prognosis.
ObjectiveTo introduce a modified sutureless technique and its surgical results in the treatment of total anomalous pulmonary venous connection (TAPVC).MethodsClinical data of 11 patients with TAPVC who underwent the modified sutureless technique treatment from 2014 to 2019 in our center were retrospectively analyzed, including 4 males and 7 females. The median surgical age was 1.4 (0.3, 27.0) months. The median weight was 4.3 (3.5, 8.5) kg.Six (54.5%) patients were of supracardiac subtype, and five (45.5%) patients were of infracardiac subtype. Five (45.5%) patients had preoperative severe pulmonary hypertension, and three (27.3%) patients had preoperative pulmonary vein obstruction. The surgical results were compared with those of 10 patients treated with conventional surgical technique.ResultsThe median follow-up was 12 (range, 1-65) months. During the follow-up, no death or postoperative pulmonary vein obstruction occurred in the modified sutureless technique group. The perioperative data and relief of re-obstruction were superior in the modified sutureless technique group, but the difference was not statistically significant (P>0.05). The postoperative survival of the the modified sutureless technique group was better than that of the traditional surgery group (P=0.049).ConclusionThe modified sutureless technique which includes partial suture and then incising, and eversion of pulmonary vein incision, is a safe and reliable method for the treatment of TAPVC with satisfactory short-term results.
ObjectiveTo review our experience of reoperations for pulmonary venous stenosis (PVS) after total anomalous pulmonary venous connection (TAPVC) repair for the past decade in Fuwai Hospital.MethodsNine patients underwent reoperation for PVS between 2009 and 2019 in Fuwai Hospital, including 4 males and 5 females with an average age of 5.10±5.00 years. The patients were divided into a sutureless group (n=3) and a non-sutureless group (n=6). Clinical data were reviewed and analyzed.ResultsFor primary TAPVC type, 4 patients were supracardiac, 2 patients were cardiac, 1 patient was infracardiac, and 2 patients were mixed-type anomaly. The median cardiopulmonary bypass time was 95 (63, 208) min, aortic clamping time was 58 (30, 110) min, ICU stay was 24 (24, 2 136) h. Early hospital death occured in 1 (11.1%) patient. One (11.1%) patient with single ventricle physiology had hospital comorbidity, who underwent hemofitration therapy. The follow-up time was 11.9 (2.2, 18.0) months, during which 1 patient died of restenosis of pulmonary vein and another patient died of stroke. No statistically significant difference was found between the sutureless group and non-sutureless group in postoperative or follow-up results (P>0.05). ConclusionSurgery is effective for treatment of PVS after repair of TAPVC, yet with a realatively high morbidity and mortality. The advantage of sutureless repair over conventional repair for this particular group of patients is yet to be verified.
ObjectiveTo investigate the risk factors for prolonged postoperative mechanical ventilation patients with total anomalous pulmonary venous connection (TAPVC). MethodsWe retrospectively analyzed the clinical data of 97 survived TAPVC patients in our hospital between June 2011 and December 2013. There were 55 males and 42 females with age of 4.4 (2, 12) months. The patients ventilated longer than mean time were as a prolonged ventilated group (n=50) and the others as a normal group (n=47). Perioperative variables between the two groups were compared and selected, then put into logistic regression analysis. ResultsFor the 97 survived patients, the mean ventilation time is 49 (25, 90) hours. Age, weight, pre-operative left ventricular end-diastolic dimension, atrial septal defect (ASD) caliber, inotropic drug dosage, postoperative left ventricular end-diastolic dimension, maximum pulmonary venous velocity (P < 0.01), and cardio-pulmonary bypass (CPB) time (P < 0.05) were statistically different between the two groups. In logistic regress analysis, age (OR=0.804 with 95%CI 0.71 to 0.91) and maximum pulmonary venous velocity (OR=1.016 with 95%CI 1.00 to 1.03) were risk factors for prolonged postoperative mechanical ventilation. ConclusionAge and maximum pulmonary venous velocity are the risk factors associated with prolonged postoperative mechanical ventilation in patients with TAPVC.
Total anomalous pulmonary venous connection (TAPVC) is a relatively rare but complex congenital heart disease characterized by the anomalous drainage of the pulmonary veins. Rather than connecting to the left atrium, the pulmonary veins drain either directly or indirectly into the systemic venous circulation or the right atrium via abnormal pathways. While there is broad consensus on the diagnostic criteria for TAPVC, significant debate persists regarding the optimal timing of surgical intervention, preferred surgical techniques, and postoperative management including re-intervention strategies. This article formulates a Chinese consensus based on evidence-based data from the literature and opinions from domestic experts, with the goal of further standardizing the surgical treatment of TAPVC in China.
Objective To analyze the sutureless technique use in the surgical repair for total anomalous pulmonary venous connection in neonates. Methods Between September 2002 and December 2015, 71 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. There were 57 males and 14 females at median age of 8 (1, 29) d. And the median body weight was 3.3 (2.1, 4.7) kg. There were 45 patients (63.4%) with supracardiac, 26 patients (36.6%) with infracardiac. Patients were divided into two groups: a conventional technique group (29 patients) and a sutureless technique group (42 patients). To control for potential differences in the characteristics of patients between the sutureless technique group and the conventional technique group, the method of propensity-score matching was used. Results Basic characteristics of patients after propensity-score were not different.There were 11 operative deaths (15.5%), 7 late deaths (96.%), total 18 deaths (25.4%). The mortality was 58.6% (17/29) in the conventional technique group, 2.4% (1/42) in the sutureless technique group (P=0.000). Kaplan-Meier survival curve showed a difference in mortality between the two groups (P=0.005). The patients were followed up for 25.5 (1.0-13.0) months.Postoperative anastomotic or pulmonary vein stenosis occurred in 12 patients, 8 of them died at a higher mortality than that of the patients with smooth anastomosis [66.7% (8/12) vs. 16.9% (10/59), P=0.001]. Conclusion The patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. Compared with conventional technique, sutureless technique can dramatically decrease the incidence of postoperative anastomotic or pulmonary vein stenosis and the mortality of surgical repair for total anomalous pulmonary venous connection in neonates.
Objective To explore the surgical management method and outcome of functional univentricular heart with total anomalous pulmonary vein drainage (UVH-TAPVD). Methods We reviewed the surgical procedures and results for 44 UVH-TAPVD patients in our hospital between the year 2010 and 2016. There were 34 males and 10 females. The age of the patients was 312 (77-4 220) d when they accepted the first surgical treatment. Results There were 8 deaths in stage Ⅰ palliation, 1 death in stage Ⅱ palliation and 5 deaths during the follow-up. The overall survival rate was 68.2% (30/44). Glenn operation was undertaken in 34 patients with 5 deaths. Fontan operation was undertaken in 9 patients with 2 deaths. Conclusion Surgical strategies for UVH-TAPVD should be planned according to different anatomical and pathophysiological conditions in different patients. Staged palliations can reduce mortality and morbidity. But pulmonary venous obstruction and heterotaxy syndrome are still risk factors for these patients.
ObjectiveTo analyze clinical outcomes of sutureless technique for patients undergoing surgical correction of total anomalous pulmonary venous connection (TAPVC). MethodsBetween July 2007 and December 2013, 132 consecutive TAPVC patients underwent surgical correction in Guangdong Cardiovascular Institute. Those patients with such associated congenital cardiac anomalies as single ventricle and right atrial isomerism were excluded from this study. All the patients underwent biventricular repair. Preoperatively, all the patients received echocardiography, and most patients received CT scan to know the development of pulmonary veins. Preoperative diagnosis was confirmed by intraoperative exploration. According to different surgical techniques, all the patients were divided to a conventional technique group and a sutureless technique group. In the conventional technique group, there were 69 patients including 54 males (78.3%)and 15 females (21.7%)with their median age of 60 (30, 225)days and median body weight of 4.85 (3.50, 6.35)kg. In the sutureless technique group, there were 63 patients including 48 males (76.20%)and 15 females (23.8%)with their median age of 90 (30, 210)days and median body weight of 4.58 (3.72, 6.20)kg. Follow-up was performed till January 1, 2014. ResultsIn-hospital mortality (4.8% vs. 7.2%, χ2=1.414, P=0.720)and postoperative overall mortality (4.8% vs. 13.0%, χ2=2.733, P=0.098)of the sutureless technique group were both lower than those of the conventional technique group, although there was no statistical difference. Postoperative incidence of pulmonary venous obstruction (PVO)of the sutureless technique group was significantly lower than that of the conventional technique group (1.6% vs. 10.1%, χ2=4.236, P=0.040). Cox proportional-hazards regression showed that conventional technique and preoperative PVO were significant risk factors for postoperative PVO (P=0.023, P=0.016). Conventional technique was not significantly correlated with postoperative mortality (P=0.060). ConclusionSutureless technique can significantly lower postoperative incidence of PVO for patients with supracardiac TAPVC.