Abstract 12998: Preoperative Venous Variability Index Predicts the Need for Pulmonary Venous Reintervention in Total Anomalous Pulmonary Venous Return

Abstract

Background: Postoperative obstruction in total anomalous pulmonary venous connection (TAPVC) is variable. Clinical risk factors are described but the role for preoperative echocardiographic markers in prognostication is unclear. Pulmonary venous variability index (PVVI), a novel metric developed at our center, is shown to better correlate to preoperative catheterization gradient and clinical markers of obstruction than standard echocardiographic measures. We hypothesized that preoperative PVVI is superior to maximum and mean velocity for prediction of outcome in TAPVC. Methods: We performed a retrospective review of TAPVC patients born 1/1/2006-9/30/2022 and repaired at our center. The medical record was reviewed for clinical and surgical risk factors. Preoperative echocardiograms were reviewed for clinical read and PVVI ((maximum velocity - minimum velocity) / mean velocity) was calculated from spectral Doppler of the pulmonary venous pathway. The outcome was time to surgical or catheter-based pulmonary vein reintervention or death. Results: In total, 162 patients were repaired. The outcome was met in 52 (32%). A univariate Cox proportional hazards model was performed for possible predictors (Table). Clinical predictors were single ventricle, heterotaxy, and a vertical vein not ligated during repair. Of echocardiographic metrics, PVVI and minimum velocity had strong associations with outcome (Figure). Conclusion: Preoperative PVVI predicts postoperative obstruction in TAPVC or death, while maximum and mean velocity and qualitative assessment of obstruction do not. Use of this quantitative metric may decrease practice variation and be valuable in prognosis.