Predictors of In-Hospital Mortality in Isolated Total Anomalous Pulmonary Venous Connection
DOI:
https://doi.org/10.1532/hsf.2415Abstract
Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary venous connection over a modern era excluding emergent cases to eliminate the influence of associated factors on surgical outcome.
Methods: 70 patients with isolated total anomalous pulmonary venous connection who were repaired electively between January 2013 and February 2018 were included.
Results: In-hospital mortality was encountered in 4 patients (5.7%). Upon univariate analysis, low age (P = .003) and weight (P = .001) at surgery, preoperative pulmonary venous obstruction (P = .010), preoperative low oxygen saturation (P = .031), long cardiopulmonary bypass (P = .001) and aortic cross clamp (P = .003) times, long duration of mechanical ventilation (P = .001), chest infection (P = 0.041), postoperative low CO syndrome (P < .001) and long postoperative inotropic support (P = .015) were significant predictors of in-hospital mortality. In multivariate analysis postoperative low cardiac output syndrome (OR: 1.060; 95% CI: 1.008-1.116) and prolonged postoperative mechanical ventilation (OR: 1.772; 95% CI: 1.141-2.751) were independent factors of in-hospital mortality.
Conclusion: Surgical repair of TAPVC is now performed with acceptable results. According to our study, postoperative low cardiac output syndrome and prolonged postoperative mechanical ventilation were the most significant predictors for early mortality.
References
Gaynor JW, Collins MH, Rychik J, Gaughan JP, Spray TL. 1999. Long-term outcome of infants with single ventricle and total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 117:506-13.
Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. 2005. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg 79:596-606.
Herlong JR, Jaggers JJ, Ungerleider RM. 2000. Congenital heart surgery nomenclature and database project: pulmonary venousanomalies. Ann Thorac Surg 69:56-69.
Husain SA, Maldonado E, Rasch D, et al. 2012. Total anomalous pulmonary venous connection: factors associated with mortality and recurrent pulmonary venous obstruction. Ann Thorac Surg 94:825-32.
Kanter KR. 2006. Surgical repair of total anomalous pulmonary venous connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 9:40-4.
Karaci AR, Harmandar B, Aydemir NA, Sasmazel A, Balci AY. 2012. Early and intermediate term results for surgical correction of total anomalous pulmonary venous connection. J Card Surg 27: 376-80.
Karamlou T, Gurofsky R, Al Sukhni E, et al. 2007. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation 115: 1591.
Kato H, Fu YY, Zhu J, Wang L, et al. 2014. Pulmonary vein stenosis and the pathophysiology of “upstream” pulmonary veins. J Thorac Cardiovasc Surg 148:245-53.
Kelle AM, Backer CL, Gossett JG, Kaushal S, Mavroudis C. 2010. Total anomalous pulmonary venous connection: results of surgical repair of 100 patients at a single institution. J Thorac Cardiovasc Surg 139:1387.
Kirshbom PM, Myung RJ, Gaynor JW, et al. 2002. Preoperative pulmonary venous obstruction affects long-term outcome for survivors of total anomalous pulmonary venous connection repair. Ann Thorac Surg 74:1616-20.
Lacour-Gayet F. 2006. Surgery for pulmonary venous obstruction after repair of total anomalous pulmonary venous return. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 45-50.
Michielon G, Di Donato RM, Pasquini L, et al. 2002. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg 22: 184-91.
Shi G, Zhu Z, Chen J, et al. 2017. Total anomalous pulmonary venous connection: the current management strategies in a pediatric cohort of 768 patients. Circulation 135:48-58.
St Louis JD, Harvey BA, Menk JS, et al. 2012. Repair of “simple” total anomalous pulmonary venous connection: a review from the Pediatric Cardiac Care Consortium. Ann Thorac Surg 94:133-7.
St Louis JD, McCracken CE, Turk EM, et al. 2018. Long-term transplant-free survival after repair of total anomalous pulmonary venous connection. Ann Thorac Surg 105:186-92.
Wu CL, Kan CD, Wu JM, Wang JM. 2016. Risk factors of total anomalous pulmonary venous connection surgery. Ped Health Res 1:1-7.
