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Wang Z, Ma K, Li S. Clinical Outcomes, Predictors, and Surgical Management of Infracardiac Total Anomalous Pulmonary Venous Connection. Pediatr Cardiol 2024:10.1007/s00246-024-03578-7. [PMID: 38980326 DOI: 10.1007/s00246-024-03578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
This study sought to find the risk factors of postoperative pulmonary venous obstruction (PVO), PVO-related reintervention, and postoperative mortality, determine the relationship between pulmonary venous confluence (PVC) morphology and the clinical outcomes, and provide the basis for the selection of the optimal surgical strategy for infracardiac total anomalous pulmonary venous connection (TAPVC). From December 2009 to December 2023, 101 patients with infracardiac TAPVC undergoing surgical repair in our institution were included [Conventional surgery (CS) group, n = 73; Sutureless technique (ST) group, n = 28]. The Kaplan-Meier curve was used to demonstrate the survival estimates. The Cox proportional hazard model was used to identify risk factors for primary endpoints. There were 8 in-hospital deaths and 4 late deaths. The survival rates at 1, 5, and 10 years were 88.8%, 87.6%, and 87.6%, respectively, in the whole cohort. Multivariable analysis showed that prolonged cardiopulmonary bypass (CBP) time was associated with overall mortality and Y-shaped PVC has a trend for a higher mortality rate. Postoperative PVO occurred in 27 patients. Freedom from postoperative PVO at 1, 5, and 10 years were 81.8%, 69.9%, and 69.9%, respectively. Y-shaped PVC and preoperative PVO were incremental risk factors for PVO, but ST repair was a protective factor. Sixteen patients underwent PVO-related reintervention. Y-shaped PVC was the only independent risk factors for PVO-related reintervention while ST repair was a protective factor. Sutureless technique can achieve satisfactory outcomes for infracardiac TAPVC repair. Compared with CS repair, ST repair is significantly associated with decreased postoperative PVO and PVO-related reintervention. Y-shaped PVC is associated with a higher risk of PVO, PVO-related reintervention, and mortality, respectively. Patients with preoperative PVO are more likely to develop postoperative PVO.
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Affiliation(s)
- Zhangwei Wang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital,, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road Xicheng, Beijing, China
| | - Kai Ma
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital,, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road Xicheng, Beijing, China
| | - Shoujun Li
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital,, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road Xicheng, Beijing, China.
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Feng Z, He Q, Yuan J, Dou Z, Wu D, Liu Y, Rui L, He F, Wu Z, Li S. Modified L-shaped incision technique for supracardiac total anomalous pulmonary venous connection as an alternative to sutureless technique. Int J Surg 2023; 109:3788-3795. [PMID: 37678273 PMCID: PMC10720858 DOI: 10.1097/js9.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The modified L-shaped incision technique (MLIT) was successfully applied to the repair of supracardiac total anomalous pulmonary venous connection (TAPVC) with promising mid-term outcomes. It is, however, unclear whether or not MLIT could be an alternative to sutureless technique (ST). METHODS All patients ( n =141) who underwent MLIT or ST repair for supracardiac TAPVC between June 2009 and June 2022 were included and a propensity score-matched analysis was performed to reduce the heterogeneity. RESULTS MLIT was performed in 80.9% (114/141), whereas ST was performed in 19.1% (27/141). Patients who underwent MLIT repair had a lower incidence of pulmonary veinous obstruction (PVO)-related reintervention (1.8 vs. 18.5%, P =0.002), and late mortality (2.6 vs. 18.2%, P =0.006). Overall survival at 10 years was 92.5% (87.7-97.7%) for MLIT and 66.8% (44.4-100%) for ST ( P =0.012). Freedom from postoperative PVO at 10 years was 89.1% (83.2-95.5%) for MLIT and 79.9% (65.6-97.4%) for ST ( P =0.12). Cox proportional hazards regression identified prolonged mechanical ventilation duration, postoperative PVO, respiratory dysfunction, and low cardiac output syndrome were associated with postoperative death and PVO-related reintervention. CONCLUSIONS The MLIT strategy is a safe, technologically feasible, and effective approach for supracardiac TAPVC, which is associated with more favorable and promising freedom from death and PVO-related reintervention.
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Affiliation(s)
- Zicong Feng
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Qiyu He
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Jianhui Yuan
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Zheng Dou
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Dongdong Wu
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yuze Liu
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Lu Rui
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Fengpu He
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, People’s Republic of China
| | - Zhongkai Wu
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou
| | - Shoujun Li
- Paediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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Bing Z, Chen R, Xing Q, Xing P, Lv B. Sutureless technique combined with vertical vein incision and pulmonary veins unroofed for correction of infracardiac total anomalous pulmonary venous connection. Front Pediatr 2023; 11:1180040. [PMID: 37492604 PMCID: PMC10364447 DOI: 10.3389/fped.2023.1180040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
Objective We report a surgical method (sutureless technique), combined with vertical vein incision and pulmonary veins unroofed (semisutureless technique), to correct infracardiac total anomalous pulmonary venous connection (TAPVC). Materials and methods The clinical characteristics of 21 patients, who were diagnosed with infracardiac TAPVS between February 2017 and March 2022, were retrospectively analyzed. These patients were divided into three groups according to different surgical methods: conventional surgery group, sutureless technique group, and semisutureless technique group. The conventional surgery group enrolled five patients with a median age of 16 days (interquartile range, 9-27 days) and a median weight of 3.25 kg (interquartile range, 3.1-3.42 kg). In this group, no preoperative pulmonary vein obstruction (PVO), preoperative ventilator support, or emergency surgery were reported. The sutureless technique group enrolled seven patients with a median age of 12 days (interquartile range, 5-16 days) and a median weight of 3.04 kg (interquartile range, 2.76-3.20 kg). In this group, two patients with preoperative PVO, four patients with preoperative ventilator support, and seven patients requiring emergency operation were found. The semisutureless technique group enrolled nine patients with a median age of 14 days (interquartile range, 7-24 days) and a median weight of 3.22 kg (interquartile range, 3.15-3.50 kg). In this group, four patients with preoperative PVO, two patients with preoperative ventilator support, and seven patients requiring emergency operation were noted. Results In the conventional surgery group, two patients with postoperative supraventricular tachycardia, one patient with postoperative low cardiac output syndrome, one patient with PVO, and no case of postoperative death were reported. In the sutureless technique group, two patients with postoperative low cardiac output syndrome, one patient with postoperative supraventricular tachycardia, one patient with postoperative PVO, and no postoperative deaths were determined. In the semisutureless technique group, three patients had low cardiac output syndrome, two patients had supraventricular tachycardia after the operation, and one patient, who had been admitted to the hospital after cardiopulmonary resuscitation in the emergency room, died early after the operation. No case of death or PVO was noted after the operation. Conclusion The semisutureless technique has positive effects. This surgery method can enlarge the anastomotic stoma, increase the volume of the left atrium, reduce the tension of the anastomotic stoma, fix the pulmonary vein to avoid distortion, and prevent postoperative hemorrhage.
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Yang Y, Lv J, Li Y, Gan C, Ji P. Intracardiac thrombosis after congenital heart disease surgeries in neonates: a report of two cases. BMC Pediatr 2023; 23:277. [PMID: 37268877 DOI: 10.1186/s12887-023-04069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Intracardiac thrombosis (ICT) is a rare complication after the cardiopulmonary surgery for interrupted aortic arch (IAA) or total anomalous pulmonary venous connection (TAPVC) without previous records. There are still no general guidelines regarding as the mechanism or management of postoperative ICT in neonates and younger infants. CASE PRESENTATION We reported the conservative and surgical therapies in two neonates with intra-ventricular and intra-atrial thrombosis after the anatomical repair for IAA and TAPVC, respectively. There were no risk factors for ICT in both patients, except for the use of blood product and prothrombin complex concentrate. The surgery was indicated after TAPVC correction due to the worsening respiratory status and rapidly decreased mixed venous saturation. Anticoagulation combined with antiplatelet therapies was adopted in another patient. These two were both finally recovered, and three-month, six-month, and one-year follow-up echocardiography revealed no abnormality. CONCLUSIONS ICT is uncommon in pediatric population after the surgery for congenital heart disease. Single ventricle palliation, heart transplantation, longer central line use, post-extracorporeal membrane oxygenation, and massive blood product use are major risk factors for postcardiotomy thrombosis. The causes of postoperative ICT are multifactorial, and the immaturity of thrombolytic and fibrinolytic system in neonates may serve as a prothrombotic factor. However, no consensus reached regarding as the therapies for postoperative ICT, and the large-scale prospective cohort study or randomized clinical trial is needed.
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Affiliation(s)
- Yanlin Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Wuhou District 610041, Chengdu, Sichuan Province, China
| | - Jing Lv
- Anesthesia Operation Center, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yajiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Changping Gan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Wuhou District 610041, Chengdu, Sichuan Province, China.
| | - Peng Ji
- Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Wuhou District 610041, Chengdu, Sichuan Province, China.
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Swartz MF, Meagher C, Yoshitake S, Atallah-Yunes N, Angona R, Cholette JM, Alfieris GM. Pulmonary Venous Gradients in Healthy Controls and Following the Repair of Total Anomalous Pulmonary Venous Return. Pediatr Cardiol 2023; 44:325-332. [PMID: 35986764 DOI: 10.1007/s00246-022-02986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
The percent of children who can achieve a normal and physiologic pulmonary venous gradient and flow following the repair of Total Anomalous Pulmonary Venous Return (TAPVR) is not known. Pulmonary venous confluence gradients from infants with supra-, infra-, or mixed TAPVR, repaired using a direct anastomotic connection were measured. Data from age, weight, and gender-matched controls established the normal pulmonary venous gradient range (0.30-0.94 mmHg). TAPVR subjects were divided into three groups: (I) pulmonary venous gradient < 2 × normal with multiphasic flow (II) pulmonary venous gradient > 2 × normal with multiphasic flow, and (III) pulmonary venous gradient > 2 × normal with monophasic flow. From 63 children following TAPVR repair and 63 matched controls, pulmonary venous gradients were significantly lower [0.5 mmHg (IQR:0.4, 0.6) vs 1.6 mmHg (IQR:1.0, 2.4); p < 0.001], and multiphasic flow more frequent (100 vs. 84.1%; p = 0.001) within the control group. There were 38 children (60.3%) in group I, 15 (23.8%) in group II, and 10 (15.8%) in group III. Children in Group I were significantly older at the time of repair, had shorter cardiopulmonary bypass times, and did not utilize deep hypothermic circulatory arrest (DHCA). Multivariate analysis confirmed that avoiding DHCA [Odds Ratio 0.931 (0.913,0.994; p = 0.002)] and shorter cardiopulmonary bypass times [Odds Ratio 0.962 (0.861,0.968; p = 0.02)] during repair were associated with the lowest pulmonary venous gradients and multiphasic flow. Following TAPVR repair with a direct anastomosis, the majority of children can achieve a gradient two times normal or less with multiphasic pulmonary venous flow.
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Affiliation(s)
- Michael F Swartz
- Pediatric Cardiac Consortium of Central New York, Rochester, USA.
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA.
| | - Cecilia Meagher
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Shuichi Yoshitake
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
| | - Nader Atallah-Yunes
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - Ron Angona
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
| | - Jill M Cholette
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
| | - George M Alfieris
- Pediatric Cardiac Consortium of Central New York, Rochester, USA
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave Box Card/Surg, Rochester, NY, 14642, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, USA
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Li G, Meng B, Zhang C, Zhang W, Zhou X, Zhang Q, Ding Y. Total anomalous pulmonary venous connection in 80 patients: Primary sutureless repair and outcomes. Front Surg 2023; 9:1086596. [PMID: 36713670 PMCID: PMC9874290 DOI: 10.3389/fsurg.2022.1086596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Total anomalous pulmonary venous connection (TAPVC) is a rare but critical cardiac anomaly, in which pulmonary veins are connected to an abnormal location rather than the left atrium. The prognosis can be extremely poor without intervention, with a mortality of 80% during infancy. The purpose of this research is to summarize the outcomes and relevant risk factors of 80 total anomalous pulmonary venous connection (TAPVC) patients who underwent primary TAPVC sutureless repair and discuss the indications and benefits of primary sutureless repair. Methods This retrospective review included 80 patients with TAPVC who underwent primary sutureless repair at a single institution between January 2015 and December 2020. Patients were subdivided into 4 groups according to Darling's classification. Risk factors that increase the postoperative pulmonary vein flow velocity were explored by Multiple Linear regression. Results Anatomic TAPVC subtypes included supracardiac 35 (43.8%), cardiac 24 (30%), infracardiac 17 (21.2%), and mixed 4 (5%). Median age at repair was 16.5 days and median weight was 3.5 kg. Preoperative pulmonary venous obstruction (PVO)was presented in 20 (25%) patients. There were 2 early deaths and 1 late death. 2 patients developed postoperative PVO and none required reintervention. Prolonged cardiopulmonary bypass time (CPB) (p = 0.009), preoperative pneumonia (p = 0.022) and gender (p = 0.041) were found to be associated with the increase of postoperative pulmonary vein flow velocity. Discussion Under the primary sutureless technique, no statistical difference was observed among the 4 subgroups in terms of postoperative pulmonary vein flow velocity (p = 0.589). The primary sutureless technique may eliminate the differences between subtypes while decrease the postoperative PVO rate, which makes it applicable in any subtypes of TAPVC. Following the favorable outcomes in preventing postoperative PVO in all subtypes in this study, we advocate the indications for primary sutureless repair may expand further to all the TAPVC patients.
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Affiliation(s)
- Gefei Li
- Department of Pediatric Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Baoying Meng
- Department of Pediatric Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Cheng Zhang
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weimin Zhang
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaodong Zhou
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Qing Zhang
- Department of Pediatric Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China,Correspondence: Qing Zhang Yiqun Ding
| | - Yiqun Ding
- Department of Pediatric Cardiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China,Correspondence: Qing Zhang Yiqun Ding
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Wang Z, Ding N, Yi H, Zhu Y, Li Z, Yan D, Li X, Bai S. Application of sutureless technique in total anomalous pulmonary venous connection repair. J Card Surg 2022; 37:3769-3775. [PMID: 35979734 DOI: 10.1111/jocs.16843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022]
Abstract
The sutureless technique was initially used for the treatment of postoperative pulmonary vein obstruction (PVO) in patients with total anomalous pulmonary venous connection (TAPVC). However, as the effectiveness of the sutureless technique has been confirmed and widely developed, the sutureless technique has been used for the primary treatment of high-risk children with TAPVC who are at high risk of PVO. Compared with traditional surgery, the sutureless technique significantly reduces the incidence of postoperative PVO, re-intervention rate due to PVO, and postoperative mortality, but there are potential complications such as pericardial and confluent venous anastomosis, phrenic nerve damage, air embolism. In addition, the sutureless technique is not effective in dealing with the progressive stenosis of the pulmonary veins after sutureless surgery and diffuse stenosis of extrapulmonary proximal veins and intrapulmonary veins. These make the efficacy and safety of this procedure controversial. This paper reviews the research status of the sutureless technique in TAPVC repair at home and abroad over the years.
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Affiliation(s)
- Zhangwei Wang
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Nan Ding
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Hanlu Yi
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Yaobin Zhu
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Zhiqiang Li
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Daole Yan
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Xiaofeng Li
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Song Bai
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
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Zhang H, Shi G, Chen H. Risk factors for postoperative pulmonary venous obstruction after surgical repair of total anomalous pulmonary venous connection: a systemic review and meta-analysis. Interact Cardiovasc Thorac Surg 2022; 35:6609775. [PMID: 35713512 PMCID: PMC9270848 DOI: 10.1093/icvts/ivac162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/21/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Han Zhang
- Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Guocheng Shi
- Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Huiwen Chen
- Department of Cardiothoracic Surgery, Congenital Heart Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
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Zhao L, Pan Z, Wu C, Shen L, Wu Y. Sutureless Technique for Primary Total Anomalous Pulmonary Venous Connection Repair: An Updated Meta-Analysis. Front Cardiovasc Med 2022; 9:890575. [PMID: 35571166 PMCID: PMC9095923 DOI: 10.3389/fcvm.2022.890575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background An updated meta-analysis was performed to explore the clinical outcomes following the sutureless repair in patients with total anomalous pulmonary venous connection (TAPVC) and compare outcomes between the sutureless technique and conventional surgery. Methods A systematic search of PubMed, Ovid-Embase, and Cochrane Library (CENTRAL) for relevant published studies that reported the clinical outcomes of the sutureless technique in children with TAPVC was performed in February 2022. The publication language was restricted to English. Results Eleven studies were included involving 771 patients in total. Following the sutureless technique, the incidences of postoperative pulmonary venous obstruction (PVO) and reoperations due to PVO were 3.3% [95% confidence interval (CI), 1.3–5.3%] and 1.8% (95% CI, 0.3–3.3%), respectively. The early and late mortality rates were 3.2% (95% CI, 1.0–5.3%) and 2.5% (95% CI, 0.7–4.3%), respectively. Compared with conventional surgery, the sutureless technique significantly reduced the incidences of postoperative PVO [odds ratio (OR), 0.16; 95% CI, 0.08–0.33; P < 0.00001], reoperations due to PVO (OR, 0.25; 95% CI, 0.10–0.63; P = 0.003), and early mortality (OR, 0.40; 95% CI, 0.21–0.79; P = 0.008). However, no significant difference was found between conventional surgery and the sutureless technique concerning late mortality (OR, 0.63; 95% CI, 0.13–3.00; P = 0.58). Conclusion The sutureless technique is superior to conventional surgery for the primary repair of TAPVC concerning postoperative PVO, reoperations due to PVO, and early mortality. However, the level of evidence is of low quality. Prospective cohort studies or randomized control trials (RCTs) should be performed to evaluate the effectiveness of sutureless techniques for primary TAPVC repair.
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Affiliation(s)
- Lu Zhao
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Lianju Shen
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
- *Correspondence: Lianju Shen,
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Yuhao Wu,
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