Primary sutureless repair for infants with total anomalous pulmonary venous connection

Abstract

Objective To retrospectively analyze the early and medium-term effect of the primary application of the sutureless repair to infant patients with total anomalous pulmonary venous connection (TAPVC).Methods One hundred and twenty-six consecutive infants(July 2007 to December 2012) with supracardiac,infracardiac and mixed-type TAPVC were retrospectively reviewed and followed up till April 2013.Survival and postoperative pulmonary venous obstruction (PVO) were compared between the sutureless group (54 cases ; median age 60 days ; body weight 4.2 kg) and the conventional group (72 cases ; median age 30 days; body weight 4.2 kg).Predictors for death and PVO were identified by an univariate and multivariate analysis using a Cox logistic method.Results No differences were noted on preoperative variables between the groups.The cardiopulmonary bypass time and aortic crossclamp time are much shorter in the sutureless group than the conventional group (83.5 min vs.100.0 min,Z =1 296.000,P =0.001 ; and 43.0 min vs.57.0 min,Z =1181.500,P =0.000,respectively).Two patients in the sutureless group and eight in the conventional group died in hospital.There was a trend toward lower in-hospital death rate in the suturelss group(3.7 ％ vs.11.1％,x2 =1.414,P =0.234).Furthermore,the rate of total death(5.6％ vs.23.6％,x2 =7.533,P=0.006) and PVO(1.9 ％ vs.16.7％,x2 =7.319,P=0.007) is decreased in the sutureless group.Adjusted by the factors of preoperative PVO,mixed-type,neonates and body weight,the conventional surgical technique is significantly related to postoperative death [HR =4.53,95 ％ CI(1.31,15.72),P =0.017] and PVO [HR =10.42,95％ CI(1.32,82.02),P =0.026].Conclusion Results Conclusions The primary sutureless repair for the patients with TAPVC appeared to be safe and effective,resulting in improved survival and freedom from PVO and reintervention. Key words: Heart disease, congenital; Cardiac surgical procedures; Total anomalous pulmonary venous connection ; Sutureless technique