Superior Approach for Supracardiac Total Anomalous Pulmonary Venous Connection

Abstract

Studies on the outcomes of surgical repair for supracardiac total anomalous pulmonary venous connection through the superior approach are uncommon. From January 2004 to January 2016, 198 patients with supracardiac total anomalous pulmonary venous connection underwent side-to-side anastomosis between the common pulmonary vein and left atrium through the superior approach. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model and competing risk regression model were used to identify risk factors for death and postoperative pulmonary venous obstruction. There were six in-hospital deaths and no late deaths. The survival rates at 30 days, 1 year, and 12 years were 97%, 97%, and 97%, respectively. Follow-up was completed in 92.2% of the survivors. Median follow-up was 47 months (range: 0 to 136 months). Twenty-seven patients (14.1%, 27 of 192) required reoperation for pulmonary venous obstruction, residual atrial septal defect, or superior cava vena syndrome. Multivariable analysis showed that preoperative pulmonary venous obstruction (p= 0.012), longer duration of ventilation (p= 0.011), and emergency operation (p= 0.010) were incremental risk factors for death. Aortic cross-clamp time (p < 0.001) and preoperative pulmonary venous obstruction (p= 0.002) were associated with postoperative pulmonary venous obstruction. Side-to-side anastomosis through a superior approach in surgical repair of supracardiac total anomalous pulmonary venous connection can achieve satisfactory results.