Early- and intermediate-term results of surgical correction in 122 patients with total anomalous pulmonary venous connection and biventricular physiology.

Keyan Zhao,Hongyu Zhu,Minhua Fang,Huishan Wang,Hengchang Song,Nanbin Zhang,Zengwei Wang,Xianyang Zhu

doi:10.1186/s13019-015-0387-6

Abstract

BackgroundWe retrospectively reported our 26-year experience with operative repair of total anomalous pulmonary venous connection (TAPVC) with biventricular physiology.MethodsBetween December 1982 and December 2008, 122 TAPVC patients with biventricular heart underwent surgical repair in our department. Moderate or deep hypothermia was induced at the time of cardiopulmonary bypass (CPB). Follow-up was conducted for 5 postoperative years. Surgical outcomes of early and intermediate deaths after TAPVC repair were retrospectively analyzed.ResultsSix deaths occurred operatively; and three deaths, during follow-up. The 5-year survival rates after TAPVC repair was 92.6 %, without gradient across the anastomosis. The survival rate of the patients who were younger was 78.8 %, significantly lower than those older than 1 year. It was also lower in those who were less than 6 kg in weight. Three patients died during follow-up. Three patients died of ventricular arrhythmia, right heart failure, and pneumonia, respectively, during follow-up. If the left atrium pressure was higher than 15 mm Hg, the snare of the vertical vein was loosened after CPB ceased in the patients with supracardiac connection. It decreased from 21 ± 5 to 13 ± 3 mm Hg. The vertical vein was ligated in 57 cases and left open in 20 cases. A patient with an intact vertical vein had a large shunt and was cured by intervention afterward. Supraventricular arrhythmia occurred in 19 patients with the supercardiac type repaired through a biatrial incision. One patient died of ventricular arrhythmia, and none of the remaining patients had arrhythmias.ConclusionSurgical treatment of TAPVC carried a low operative risk and had satisfactory immediate and intermediate results. Age younger than 1 year and weight less than 6 kg were risk factors. It was a good choice to leave the vertical vein open in the patients with a left atrial pressure higher than 15 mm Hg.

Highlights

We retrospectively reported our 26-year experience with operative repair of total anomalous pulmonary venous connection (TAPVC) with biventricular physiology
While surgical repair of TAPVC has historically been associated with a significant risk of early mortality, with reports in the literature ranging from 10 % to 50 % [5, 6]
Earlier studies indicated that biventricular patients with preoperative pulmonary venous obstruction were at a high risk of post-repair pulmonary venous obstruction, which this has been neutralized as a risk factor in some morerecent studies [11]

Summary

Introduction

We retrospectively reported our 26-year experience with operative repair of total anomalous pulmonary venous connection (TAPVC) with biventricular physiology. Many reports have argued that among patients with congenital heart defects, those with TAPVC and singleventricle physiology have the poorest survival [7,8,9]. These patients undergo procedures including Fontan, bidirectional Glenn, systemic-pulmonary shunt, or pulmonary artery banding, obviously with high operative mortality and poor long-term survival [4, 10]. We report retrospectively our 26-year experience with TAPVC and biventricular physiology, including clinical presentations, operative techniques, results, and survival. We discussed how to manage the vertical vein

Methods

Results

Discussion

Conclusion