Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-06-01T10:35:01.963Z Has data issue: false hasContentIssue false
  • English
  • Français

Reintervention and mortality risk after total anomalous pulmonary venous connection repair

Published online by Cambridge University Press:  13 January 2023

Kevin M. Beers Open the ORCID record for Kevin M. Beers [Opens in a new window] ,
Christian P. Jacobsen ,
Stewart R. Miller ,
David G. Lehenbauer Open the ORCID record for David G. Lehenbauer [Opens in a new window] ,
Elaine Maldonado ,
S. Adil Husain Open the ORCID record for S. Adil Husain [Opens in a new window]  and
John H. Calhoon
Kevin M. Beers*
Affiliation:
Department of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA
Christian P. Jacobsen
Affiliation:
Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
Stewart R. Miller
Affiliation:
University of Texas San Antonio College of Business, San Antonio, TX, USA
David G. Lehenbauer
Affiliation:
Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Elaine Maldonado
Affiliation:
Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
S. Adil Husain
Affiliation:
Department of Surgery and Pediatrics, University of Utah Health Salt Lake City, UT, USA
John H. Calhoon
Affiliation:
Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
*
Author for correspondence: Kevin M. Beers, DO. 92 W. Miller Street, MP 307, Orlando, FL 32806, USA. Tel: +1 (321) 841 6128; Fax: +1 (407) 841 4260. E-mail: Kevin.beers@orlandohealth.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Management of total anomalous pulmonary venous connections has been extensively studied to further improve outcomes. Our institution previously reported factors associated with mortality, recurrent obstruction, and reintervention. The study purpose was to revisit the cohort of patients and evaluate factors associated with reintervention, and mortality in early and late follow-up.

Methods:

A retrospective review at our institution identified 81 patients undergoing total anomalous pulmonary venous connection repair from January 2002 to January 2018. Demographic and operative variables were evaluated. Anastomotic reintervention (interventional or surgical) and/or mortality were primary endpoints.

Results:

Eighty-one patients met the study criteria. Follow-up ranged from 0 to 6,291 days (17.2 years), a mean of 1263 days (3.5 years). Surgical mortality was 16.1% and reintervention rates were 19.8%. In re-interventions performed, 80% occurred within 1.2 years, while 94% of mortalities were within 4.1 months. Increasing cardiopulmonary bypass times (p = 0.0001) and the presence of obstruction at the time of surgery (p = 0.025) were predictors of mortality, while intracardiac total anomalous pulmonary venous connection type (p = 0.033) was protective. Risk of reintervention was higher with increasing cardiopulmonary bypass times (p = 0.015), single ventricle anatomy (p = 0.02), and a post-repair gradient >2 mmHg on transesophageal echocardiogram (p = 0.009).

Conclusions:

Evaluation of a larger cohort with longer follow-up demonstrated the relationship of anatomic complexity and symptoms at presentation to increased mortality risk after total anomalous pulmonary venous connection repair. The presence of a single ventricle or a post-operative confluence gradient >2 mmHg were risk factors for reintervention. These findings support those found in our initial study.

Keywords

Paediatric cardiac surgerytotal anomalous pulmonary venous connectionreintervention (pulmonary vein stenosis)
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2228 - 2235
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Husain, SA, Maldonado, E, Rasch, D, et al. Total anomalous pulmonary venous connection: factors associated with mortality and recurrent pulmonary venous obstruction. Ann Thorac Surg 2012; 94: 825–831.CrossRefGoogle ScholarPubMed
Yong, MS, Yaftian, N, Griffiths, S, et al. Long-term outcomes of total anomalous pulmonary venous drainage repair in neonates and infants. Ann Thorac Surg 2018; 105: 1232–1239.10.1016/j.athoracsur.2017.10.048CrossRefGoogle ScholarPubMed
Reller, MD, Strickland, MJ, Riehle-Colarusso, T, Mahle, WT, Correa, A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr 2008; 153: 807–813.CrossRefGoogle ScholarPubMed
Kirshbom, PM, Myung, RJ, Gaynor, WG, et al. Preoperative pulmonary venous obstruction affects long-term outcome for survivors of total anomalous pulmonary venous connection repair. Ann Thorac Surg 2002; 74: 1616–1620.CrossRefGoogle ScholarPubMed
Yanagawa, B, Alghamdi, AA, Dragulescu, A, et al. Primary sutureless repair for, simple, total anomalous pulmonary venous connection: midterm results in a single institution. J Thorac Cardiovasc Surg 2011; 141: 1346–1354.CrossRefGoogle ScholarPubMed
St. Louis, JD, Harvey, BA, Menk, JS, et al. Repair of, simple, total anomalous pulmonary venous connection: a review from the pediatric cardiac care consortium. Ann Thorac Surg 2012; 94: 133–138.CrossRefGoogle ScholarPubMed
Caldarone, CA, Najm, HK, Kadletz, M, et al. Surgical management of total anomalous pulmonary venous drain-age: impact of coexisting cardiac anomalies. Ann Thorac Surg 1998; 66: 1521–26.10.1016/S0003-4975(98)00951-5CrossRefGoogle Scholar
Caldarone, CA, Najm, HK, Kadletz, M, et al. Relent-less pulmonary vein stenosis after repair of total anoma-lous pulmonary venous drainage. Ann Thorac Surg 1998; 66: 1514–1520.CrossRefGoogle Scholar
White, BR, Ho, DY, Faerber, JA, et al. Repair of total anomalous pulmonary venous connection: risk factors for postoperative obstruction. Ann Thorac Surg 2019; 108: 122–129.CrossRefGoogle ScholarPubMed
Hancock Friesen, CL, Zurakowski, D, Thiagarajan, RR, et al. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg 2005; 79: 596–606.10.1016/j.athoracsur.2004.07.005CrossRefGoogle ScholarPubMed
Michielon, G, Di Donato, RM, Pasquini, L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg 2002; 22: 184–191.CrossRefGoogle ScholarPubMed
Karamlou, T, Gurofsky, R, Al Sukhni, E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation 2007; 115: 1591–1598.CrossRefGoogle ScholarPubMed
Seale, AN, Uemura, H, Webber, SA, et al. Total anomalous pulmonary venous connection: outcome of postoperative pulmonary venous obstruction. J Thorac Cardiovasc Surg 2013; 145: 1255–1262.10.1016/j.jtcvs.2012.06.031CrossRefGoogle ScholarPubMed
St. Louis, JD, McCracken, CE, Turks, EM, et al. Long-term transplant-free survival after repair of total anomalous pulmonary venous connection. Ann Thorac Surg 2018; 105: 186–192.CrossRefGoogle ScholarPubMed
Vanderlaan, RD, Caldarone, CA. Surgical approaches to total anomalous pulmonary venous connection. In Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. vol. 21, p. 83–91.Google Scholar
Kelle, AM, Backer, CL, Gossett, JG, et al. Total anomalous pulmonary venous connection: results of surgical repair of 100 patients at a single institution. J Thorac Carciovasc Surg 2010; 139: 1387–1394.CrossRefGoogle ScholarPubMed
Gottlieb, EA, Andropoulos, DB. Current and future trends in coagulation management for congenital heart surgery. J Thorac Cardiovasc Surg 2017; 153: 1511–1515.CrossRefGoogle ScholarPubMed
Herlong, JR, Li, JS, Bengur, AR, Ungerleider, RM. Pulmonary vein Doppler echocardiography after left atrial operation. Ann Thorac Surg 1995; 60: 678–680.CrossRefGoogle ScholarPubMed
Hsia, TY, McQuinn, TC, Mukherjee, R, et al. Effects of Aprotinin or tranexamic acid on proteolytic/cytokine profiles in infants after cardiac surgery. Ann Thorac Surg 2010; 89: 1843–1852.10.1016/j.athoracsur.2010.02.069CrossRefGoogle ScholarPubMed
Pasquali, SK, Hall, M, Li, JS, et al. Safety of Aprotinin in congenital heart operations: results from a large multicenter database. Ann Thorac Surg 2010; 90: 14–21.10.1016/j.athoracsur.2010.02.073CrossRefGoogle ScholarPubMed
Kilic, A, Whitman, GJR. Blood transfusions in cardiac surgery: indications, risks, and conservation strategies. Ann Thorac Surg 2014; 97: 726–734.CrossRefGoogle ScholarPubMed
Lacour-Gayet, F, Zoghbi, J, Serraf, AE, et al. Surgical management of progressive pulmonary venous obstruction after repair of total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 1999; 117: 679–687.CrossRefGoogle ScholarPubMed