Surgical treatment of infracardiac total anomalous pulmonary venous connection: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEN Chen ¹ , ZHU Fang ¹ , ZHANG Qian ¹ , HU Chen ² , CHEN Hao ¹ , QIU Lisheng ¹ , SHI Guocheng ¹ , ZHANG Hao ¹ , ZHU Zhongqun ¹ ,  CHEN Huiwen ¹

1. Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P.R.China;
2. Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China;

Corresponding author：

CHEN Huiwen, Email: chenhuiwen@scmc.com.cn

Keywords：

Total anomalous pulmonary venous connection; sutureless technique; surgery; treatment; complications; pulmonary venous obstruction

DOI：

10.7507/1007-4848.201911019

Video：

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Objective To compare the outcomes of sutureless technique and conventional technique in the surgical repair for infracardiac total anomalous pulmonary venous connection (TAPVC).Methods The clinical data of 46 consecutive patients with infracardiac TAPVC undergoing surgical repair in our hospital between June 2014 and April 2019 were retrospectively analyzed. Patients with combined congenital cardiac anomalies such as single ventricle and tetralogy of Fallot were excluded. Patients were divided into a conventional technique group and a sutureless technique group according to the surgical techniques. There were 35 patients in the conventional technique group, including 28 males (80.0%) and 7 females (20.0%) with a median age of 21 (8, 42) d and a median weight of 3.6 (3.0, 4.0) kg. There were 11 patients in the sutureless technique group, including 8 males (72.7%) and 3 females (27.3%) with a median age of 14 (6, 22) d and a median weight of 3.5 (2.9, 3.6) kg. The curative effect of the two groups was compared.Results There were 5 deaths (10.9%) in the conventional technique group, including 4 in-hospital deaths (8.7%) and 1 late death (2.2%). Overall mortality of the conventional technique group (14.3%, 5/35) was higher than that of the sutureless technique group (0.0%, 0/11), although the difference was not statistically significant (P=0.317). Cox regression analysis showed that sex (P=0.042), age at repair (P=0.028), cardiopulmonary bypass time (P=0.007), aortic cross-clamping time (P=0.018) and duration of ventilation (P=0.042) were risk factors for postoperative mortality. The median follow-up was 18.00 (5.00, 37.75) months. Postoperative pulmonary venous obstruction occurred in 22 patients of the conventional technique group, which was significantly more than that of the sutureless technique group (P=0.000).Conclusion For infracardiac TAPVC, sutureless technique can reduce the incidence of postoperative pulmonary venous obstruction compared with conventional technique.

Citation： WEN Chen, ZHU Fang, ZHANG Qian, HU Chen, CHEN Hao, QIU Lisheng, SHI Guocheng, ZHANG Hao, ZHU Zhongqun, CHEN Huiwen. Surgical treatment of infracardiac total anomalous pulmonary venous connection: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(5): 510-514. doi: 10.7507/1007-4848.201911019 Copy

1.	Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: the current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
2.	St Louis JD, Harvey BA, Menk JS, et al. Repair of "simple" total anomalous pulmonary venous connection: a review from the Pediatric Cardiac Care Consortium. Ann Thorac Surg, 2012, 94(1): 133-137.
3.	Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome. Eur J Cardiothorac Surg, 2003, 24(1): 28-36.
4.	Husain SA, Maldonado E, Rasch D, et al. Total anomalous pulmonary venous connection: factors associated with mortality and recurrent pulmonary venous obstruction. Ann Thorac Surg, 2012, 94(3): 825-831.
5.	Lacour-Gayet F. Surgery for pulmonary venous obstruction after repair of total anomalous pulmonary venous return. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006: 45-50.
6.	White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: risk factors for postoperative obstruction. Ann Thorac Surg, 2019, 108(1): 122-129.
7.	Kalfa D, Belli E, Bacha E, et al. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg, 2018, 156(1): 278-286.
8.	Eyries M, Montani D, Girerd B, et al. EIF2AK4 mutations cause pulmonary veno-occlusive disease, a recessive form of pulmonary hypertension. Nat Genet, 2014, 46(1): 65-69.
9.	Krenning G, Barauna VG, Krieger JE, et al. Endothelial plasticity: shifting phenotypes through force feedback. Stem Cells Int, 2016, 2016: 9762959.
10.	Alsoufi B. Cracking the mystery of pulmonary vein stenosis. Semin Thorac Cardiovasc Surg, 2019, 31(2): 274-276.
11.	Kato H, Fu YY, Zhu J, et al. Pulmonary vein stenosis and the pathophysiology of "upstream" pulmonary veins. J Thorac Cardiovasc Surg, 2014, 148(1): 245-253.
12.	Zhu J, Ide H, Fu YY, et al. Losartan ameliorates "upstream" pulmonary vein vasculopathy in a piglet model of pulmonary vein stenosis. J Thorac Cardiovasc Surg, 2014, 148(6): 2550-2557.
13.	Lacour-Gayet F, Rey C, Planché C. Pulmonary vein stenosis. Description of a sutureless surgical procedure using the pericardium in situ. Arch Mal Coeur Vaiss, 1996, 89(5): 633-636.
14.	Yun TJ, Coles JG, Konstantinov IE, et al. Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies. J Thorac Cardiovasc Surg, 2005, 129(1): 167-174.
15.	Yun TJ, Al-Radi OO, Adatia I, et al. Contemporary management of right atrial isomerism: effect of evolving therapeutic strategies. J Thorac Cardiovasc Surg, 2006, 131(5): 1108-1113.

1. Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: the current management strategies in a pediatric cohort of 768 patients. Circulation, 2017, 135(1): 48-58.
2. St Louis JD, Harvey BA, Menk JS, et al. Repair of "simple" total anomalous pulmonary venous connection: a review from the Pediatric Cardiac Care Consortium. Ann Thorac Surg, 2012, 94(1): 133-137.
3. Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome. Eur J Cardiothorac Surg, 2003, 24(1): 28-36.
4. Husain SA, Maldonado E, Rasch D, et al. Total anomalous pulmonary venous connection: factors associated with mortality and recurrent pulmonary venous obstruction. Ann Thorac Surg, 2012, 94(3): 825-831.
5. Lacour-Gayet F. Surgery for pulmonary venous obstruction after repair of total anomalous pulmonary venous return. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2006: 45-50.
6. White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: risk factors for postoperative obstruction. Ann Thorac Surg, 2019, 108(1): 122-129.
7. Kalfa D, Belli E, Bacha E, et al. Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. J Thorac Cardiovasc Surg, 2018, 156(1): 278-286.
8. Eyries M, Montani D, Girerd B, et al. EIF2AK4 mutations cause pulmonary veno-occlusive disease, a recessive form of pulmonary hypertension. Nat Genet, 2014, 46(1): 65-69.
9. Krenning G, Barauna VG, Krieger JE, et al. Endothelial plasticity: shifting phenotypes through force feedback. Stem Cells Int, 2016, 2016: 9762959.
10. Alsoufi B. Cracking the mystery of pulmonary vein stenosis. Semin Thorac Cardiovasc Surg, 2019, 31(2): 274-276.
11. Kato H, Fu YY, Zhu J, et al. Pulmonary vein stenosis and the pathophysiology of "upstream" pulmonary veins. J Thorac Cardiovasc Surg, 2014, 148(1): 245-253.
12. Zhu J, Ide H, Fu YY, et al. Losartan ameliorates "upstream" pulmonary vein vasculopathy in a piglet model of pulmonary vein stenosis. J Thorac Cardiovasc Surg, 2014, 148(6): 2550-2557.
13. Lacour-Gayet F, Rey C, Planché C. Pulmonary vein stenosis. Description of a sutureless surgical procedure using the pericardium in situ. Arch Mal Coeur Vaiss, 1996, 89(5): 633-636.
14. Yun TJ, Coles JG, Konstantinov IE, et al. Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies. J Thorac Cardiovasc Surg, 2005, 129(1): 167-174.
15. Yun TJ, Al-Radi OO, Adatia I, et al. Contemporary management of right atrial isomerism: effect of evolving therapeutic strategies. J Thorac Cardiovasc Surg, 2006, 131(5): 1108-1113.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of infracardiac total anomalous pulmonary venous connection: A retrospective cohort study

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