Clinical Analysis Of Surgical Treatment For The Total Anomalous Pulmonary Venous Connection

Objective:Total anomalous pulmonary venous connection(TAPVC)is a rare congenital heart disease.The most common type is supracardiac connection.In this study,we comparised the curative effects between traditional cardiac approach and the modified surgical techniques for the treatment of supracardiac total anomalous pulmonary venous connection.Methods:104 children from January 2011 to January 2017,with total anomalous pulmonary venous connection in our center underwent surgery by CPB,after general anesthesia.Fifty-six of them underwent the left atrium anastomosis with the common vein by the traditional cardiac approach.Forty-eight of them used this modified superior approach with transection of the superior vena cava and Sutureless technique.The cardiopulmonary bypass time,the aortic cross-clamp time,postoperative ventilator service time,the days in ICU,total hospital stays,mortality of postoperative 30-day,total mortality,postoperative pulmonary vein stenosis or pulmonary vein obstruction were observed.Kaplan-meier curve was used to analyze the overall survival rate and the risk of postoperative pulmonary vein obstruction,and Cox regression was used to analyze the risk factors of postoperative pulmonary vein stenosis or postoperative pulmonary vein obstruction.Results:The average weight of the patients was 4.5±1.3kg.The median of cardiopulmonary bypass time: 91(55,210)min in the traditional surgery group and89(50,120)min in the modified surgery group,P<0.05.The median of aortic cross-clamp time:48(20,113)min in the traditional surgery group and 45(15,75)min in the modified surgery group,P<0.05.The median of postoperative ventilator service time:107(16,1368)h in the traditional surgery group and 120(6,696)h in the modified surgery group,P>0.05.Average hospital stays: 24.5±17.9 days in the traditional surgery group and 17.4±7.9 days in the modified surgery group,P<0.05.Postoperative complications included: Three patients had low cardiac output syndrome(2.88%).One had pulmonary hypertension crisis(0.96%).Two patients suffered multiple organ dysfunction syndrome(1.92%).Five cases had pleural effusion(4.81%).Two cases had pneumothorax(1.92%).The 30-day mortality rate of postoperative was6.73%(7/104),8.93%(5/56)in the traditional surgery group and 4.17%(2/48)in the modified surgery group,P>0.05.A total of 101 patients were followed up,3 patients lost to follow-up.The average time of follow-up was 32.8±0.9months.The survival rates were 89.3%(the first year),87.5%(the second year)and 87.3%(the third year)in the traditional surgery group.95.8%(the first year),91.7%(the second year)and 91.5%(the third year)in the modified surgery group.During the follow-up,sixteen children had postoperative pulmonary vein stenosis or pulmonary vein obstruction,13(23.21%)after traditional methods and 3(6.25%)after the modified methods,P<0.05.And 10 of them was anastomotic stenosis,6 of them was the original pulmonary vein stenosis.The rest recovered and were discharged from the hospital.Risk factors for postoperative PVO included: low weight,low age,preoperative pulmonary vein obstruction,and traditional surgical methods,by Cox regression model analysis.Conclusion:The surgical treatment of supracardiac total anomalous pulmonary venous connection has a distinctly effect.Modified transection superior vena cava and Sutureless technique can reduce postoperative PVO.The overall survival rate after surgery is satisfactory.Low weight,low age,traditional surgical methods and preoperative pulmonary vein obstruction were risk factors of postoperative PVO.