Total Anomalous Pulmonary Venous Connection The Current Management Strategies in a Pediatric Cohort of 768 Patients

Article

关键词: PRIMARY SUTURELESS REPAIR;    SINGLE INSTITUTION;    VEIN STENOSIS;    OBSTRUCTION;    DRAINAGE;    MORTALITY;    OUTCOMES;    SURGERY;    INFANTS;   

DOI  :  10.1161/CIRCULATIONAHA.116.023889

来源: SCIE

【 摘 要 】

BACKGROUND: Total anomalous pulmonary venous connection (TAPVC) is a rare form of congenital heart disease. This study describes current surgical treatment strategies and experiences in a cohort of patients from 2 congenital cardiac centers in Shanghai and Guangdong in China. METHODS: This retrospective study included 768 patients operated on between 2005 and 2014. Although most patients (n = 690) underwent conventional repair, a sutureless technique was used in 10% (n = 78) of cases. A multilevel mixed-effects parametric survival model and a competing-risk analysis were used to analyze associated risk factors for death and recurrent pulmonary venous obstruction (PVO), respectively. Kaplan-Meier analysis was used to analyze the overall survival. The NelsonAalen cumulative risk curve was used to compare distributions of time with recurrent PVO. RESULTS: The mean surgical age and weight were 214.9 +/- 39.2 days and 5.4 +/- 3.6 kg, respectively. Obstructed TAPVC (PVO) was documented in 192 (25%) of the 768 patients. There were 38 intraoperative deaths and 13 late deaths. A younger age at the time of repair (P = 0.001), mixed (P = 0.004) and infracardiac (P = 0.035) TAPVC, preoperative PVO (P = 0.027), prolonged cardiopulmonary bypass time (P < 0.001), and longer duration of ventilation (P = 0.028) were associated with mortality. The median follow-up was 23.2 months (range; 1-112 months). Among the 717 survivors, recurrent PVO was observed in 111 patients (15%). Associated risk factors for recurrent PVO included preoperative PVO (P < 0.001), infracardiac TAPVC (P < 0.001), mixed TAPVC (P = 0.013), and prolonged cardiopulmonary bypass time (P < 0.001). Sutureless technique was associated with a lower restenosis rate compared with conventional repair in patients with preoperative PVO (P = 0.038), except in newborn patients (P = 0.443). Reintervention for restenosis was performed in 24 patients. The function of most survivors (91%) was classified according to the New York Heart Association as functional class I or II. CONCLUSIONS: Surgical correction in patients with TAPVC with a biventricular anatomy can achieve an acceptable outcome. Risk factors such as a younger age at the time of repair, infracardiac and mixed TAPVC, and preoperative PVO were associated with a poorer prognosis.

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