Sutureless technique use in the surgery for total anomalous pulmonary venous connection in neonates_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xiaohua ,  CHEN Jimei , ZHUANG Jian , NIE Zhiqiang , CEN Jianzheng , WEN Shusheng , XU Gang , GAO Qiang , ZHAO Junfei

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, P.R.China;

Corresponding author：

CHEN Jimei, Email: jimei@hotmail.com

Keywords：

Sutureless technique; neonates; total anomalous pulmonary venous connection; surgery

DOI：

10.7507/1007-4848.201612049

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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.

Citation： LI Xiaohua, CHEN Jimei, ZHUANG Jian, NIE Zhiqiang, CEN Jianzheng, WEN Shusheng, XU Gang, GAO Qiang, ZHAO Junfei. Sutureless technique use in the surgery for total anomalous pulmonary venous connection in neonates. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(9): 661-666. doi: 10.7507/1007-4848.201612049 Copy

1.	Michielon G, Di Donato RM, Pasquini L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg, 2002, 22(2): 184-191.
2.	Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
3.	Sano S, Brawn WJ, Mee RB. Total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg, 1989, 97(6): 886-892.
4.	Najm HK, Caldarone CA, Smallhorn J, et al. A sutureless technique for the relief of pulmonary vein stenosis with the use of in situ pericardium. J Thorac Cardiovasc Surg, 1998, 115(2): 468-470.
5.	Ding YQ, Chen JM, Cen JI, et al. Extended anastomosis with suture-less technique for primary repair of supra-cardiac TAPVC. S Chin J Cardiol, 2010, (4): 222-227.
6.	Kirklin JW. Surgical treatment of anomalous pulmonary venous connections. Pro Staff Meet Mayo Clin, 1953, 28(17): 476-479.
7.	Phillips SJ, Kongtahworn C, Zeff RH, et al. Correction of total anomalous pulmonary venous connection below the diaphragm. Ann Thorac Surg, 1990, 49(5): 734-739.
8.	Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest, 1957, 6(1): 44-64.
9.	Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
10.	李晓华, 庄建, 陈寄梅, 等. 新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1138-1142.
11.	庄建, 张镜芳, 吴若彬, 等. 38 例完全性肺静脉异位引流的外科治疗. 中华胸心血管外科杂志,1999, 15(6): 6-8.
12.	丁以群, 庄建, 陈寄梅, 等. 应用无内膜接触缝合技术治疗心上型全肺静脉异位引流. 中华胸心血管外科杂志, 2010, 26(2): 73-75.
13.	Tucker BL, Lindesmith GC, Stiles QR, et al. The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. Ann Thorac Surg, 1976, 22(4): 374-377.
14.	Bret EL, Roubertie F, Belli E, et al. Supracardiac total anomalous pulmonary venous connection: the transaortopulmonary approach. Ann Thorac Surg, 2009, 88(3): e27-e28.
15.	Cobanoglu A, Menashe VD. Total anomalous pulmonary venous connection in neonates and young infants: Repair in the current era. Ann Thorac Surg, 1993, 55(1): 43-49.
16.	Tweddell JS. The vertical vein: To ligate or not to ligate. J Thorac Cardiovasc Surg, 2007, 133(5):1135-1136.
17.	Cope JT, Banks D, Mcdaniel NL, et al. Is vertical vein ligation necessary in repair of total anomalous pulmonary venous connection?. Ann Thorac Surg, 1997, 64(1): 23.

1. Michielon G, Di Donato RM, Pasquini L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg, 2002, 22(2): 184-191.
2. Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
3. Sano S, Brawn WJ, Mee RB. Total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg, 1989, 97(6): 886-892.
4. Najm HK, Caldarone CA, Smallhorn J, et al. A sutureless technique for the relief of pulmonary vein stenosis with the use of in situ pericardium. J Thorac Cardiovasc Surg, 1998, 115(2): 468-470.
5. Ding YQ, Chen JM, Cen JI, et al. Extended anastomosis with suture-less technique for primary repair of supra-cardiac TAPVC. S Chin J Cardiol, 2010, (4): 222-227.
6. Kirklin JW. Surgical treatment of anomalous pulmonary venous connections. Pro Staff Meet Mayo Clin, 1953, 28(17): 476-479.
7. Phillips SJ, Kongtahworn C, Zeff RH, et al. Correction of total anomalous pulmonary venous connection below the diaphragm. Ann Thorac Surg, 1990, 49(5): 734-739.
8. Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest, 1957, 6(1): 44-64.
9. Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
10. 李晓华, 庄建, 陈寄梅, 等. 新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1138-1142.
11. 庄建, 张镜芳, 吴若彬, 等. 38 例完全性肺静脉异位引流的外科治疗. 中华胸心血管外科杂志,1999, 15(6): 6-8.
12. 丁以群, 庄建, 陈寄梅, 等. 应用无内膜接触缝合技术治疗心上型全肺静脉异位引流. 中华胸心血管外科杂志, 2010, 26(2): 73-75.
13. Tucker BL, Lindesmith GC, Stiles QR, et al. The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. Ann Thorac Surg, 1976, 22(4): 374-377.
14. Bret EL, Roubertie F, Belli E, et al. Supracardiac total anomalous pulmonary venous connection: the transaortopulmonary approach. Ann Thorac Surg, 2009, 88(3): e27-e28.
15. Cobanoglu A, Menashe VD. Total anomalous pulmonary venous connection in neonates and young infants: Repair in the current era. Ann Thorac Surg, 1993, 55(1): 43-49.
16. Tweddell JS. The vertical vein: To ligate or not to ligate. J Thorac Cardiovasc Surg, 2007, 133(5):1135-1136.
17. Cope JT, Banks D, Mcdaniel NL, et al. Is vertical vein ligation necessary in repair of total anomalous pulmonary venous connection?. Ann Thorac Surg, 1997, 64(1): 23.

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