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| Primary Sutureless Procedure for ‘Simple’ Total Anomalous Pulmonary Venous Connection: Mid-Term Results in a Single Institution |
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Bobby Yanagawa, Abdullah A. Alghamdi, Christopher A. Caldarone, John G. Coles, Osman O. Al-Radi, Glen Van Arsdell; Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada Objective: The outcomes for the repair of total anomalous pulmonary venous connection (TAPVC) continue to be complicated by pulmonary vein stenosis (PVS), particularly with young age at initial surgery, infracardiac connection type and existing PVS. We have previously reported the use of a sutureless repair for surgical management of iatrogenic PVS. Because of potential benefits of achieving maximal performance from small pulmonary veins by not having associated suture lines and the potential for precluding post repair development of pulmonary vein stenosis, we have been evolving to utilizing a primary sutureless repair technique for TAPVC - particularly for those at increased risk for PVS. Methods: Fifty-seven patients (median age 15 days [1 to 1157 days] and median weight 3.4kg [1.7 to 11.7kg]) underwent a sutureless or classical TAPVC repair from 1/97 to 7/09. Median follow-up time was 2.9 years (5 days to 11.7 years). Comparisons were made for preoperative characteristic and outcomes between sutureless and classical repair. Results: Types of TAPVC included 31 (54%) supracardiac, 15 (26%) cardiac and 11 (19%) infracardiac. Preoperative PVS was seen in 8 (14.0%) and vertical vein obstruction in 35 (61.4%) patients. A primary sutureless repair with in situ pericardium was carried out successfully in 21 (36.8%; supracardiac n=12, cardiac n=4, infracardiac n=5) patients. There was a trend for greater preoperative PVS (23.8% vs. 5.3%) and significantly higher vertical vein obstruction (81.0 vs. 50.0%; P<0.02) in the sutureless repair as compared to the classical repair. Primary outcomes of reoperation for PVS [n= 1 (classical repair) 1.9%] or death [n=2; 3.8%] were not different. Furthermore, post-operative PVS scores were similar between two repair groups. Conclusion: Primary sutureless repair has equivalent outcomes to classical repair of TAPVC in the presence of higher levels of preoperative stenosis. The lack of late development of PVS in 21 infants including 5 infracardiac type suggests that continued evaluation of primary sutureless repair is warranted. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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