Early- and intermediate-term results of surgical correction in 328 patients with different drainage type of total anomalous pulmonary venous connection

Abstract

Objective This retrospective cohort study aims to evaluate and compare the prognosis of surgical repair for total anomalous pulmonary venous connection(TAPVC) with different drainage type. Methods From January 2006 to December 2013, 328 consecutive patients were enrolled in this study. The distribution of the defects was 109 cases with cardiac, 161 with supracardiac, 32 with infracardiac, and 26 with mixed type of the drainage into the systemic circulation. The clinical records of all the patients were reviewed. Studied variables were extracted from the clinical records. Followed-up was conducted at an interval of 1 month, 3 months, 6 months and then once a year post-operation. Prevalence of peri-operative conditions were compared among four different types. Studied endpoints was defined by postoperative total death or pulmonary venous obstruction(PVO), which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model, adjusted by different surgical strategy, emergency operation, preoperative-PVO, neonates, weight, combing with other complex cardiac defects, NYHA cardiac function, severe pulmonary hypertension and severe tricuspid regurgitation. Results There were significant discrepancy of preoperative conditions among four types of TAPVC. Patients with infracardiac TAPVC presented the most critical symptoms and clinical indexes, which included having largest proportion of neonates, preoperative PVO, severe NYHA grading, pulmonary hypertension and tricuspid regurgitation, having lowest body weight at operation and youngest age. The cardiopulmonary bypass time, aortic crossclamp time and mechanical ventilation time were significantly longer in infracadiac and mixed TAPVC comparing to the other two types. For early mortality(death in hospital), infracadiac(9.4%) and mixed(11.5%) TAPVC demonstrated higher rates of death than cardiac(4.6%) and supracardiac(7.5%)TAPVC, although had no statistical significance. For intermediate-term results, mortality in infracadiac(21.9%) and mixed(30.8%) TAPVC were significantly higher than cardiac(8.3%)and supracardiac(11.8%)TAPVC. Reoperation was more frequently required in mixed(19.2%), then infracadiac(15.6%)TAPVC. Mixed and infracadiac types are independent risk factors for TAPVC prognosis, after adjusting by the confounding factors. Conclusion Mixed and infracadiac types are independent risk factors for postoperative death and PVO among TAPVC patients. This study provided evidence for clinical assessment and management strategy for different types of TAPVC. Key words: Heart surgery; Total anomalous pulmonary venous connection; Pulmonary venous obstruction