Primary sutureless repair for infants with mixed total anomalous pulmonary venous drainage

Mixed type total anomalous pulmonary venous drainage (TAPVD) poses technical challenges and high mortality owing to diminutive size and remote location of the pulmonary vein (PV) confluences. We hypothesized that primary application of sutureless repair may better incorporate small and remote confluences, thereby minimizing PV stenosis and improving outcomes.

Twenty-two consecutive infants (1985 to 2009; median age 27 days; body weight 3.7 kg) with mixed type TAPVD were retrospectively reviewed. Survival and reintervention were compared between the sutureless group (n = 8) and the conventional group (n = 14). Predictors for death and reintervention were identified by an univariate analysis using a chi(2) test.

No differences were noted on preoperative and intraoperative variables between the groups. There were 5 early deaths in the conventional group and no deaths in the sutureless group (p = 0.05). There were trends toward improved survival (100% versus 57% at 1 year, p = 0.07) and freedom from reintervention (100% versus 67% at 1 year, p = 0.09) in the sutureless group. The univariate analysis showed that preoperative PV obstruction (p = 0.05), conventional repair (p = 0.05), palliative surgery (p = 0.001), and residual PV obstruction (p = 0.002) were the risk factors for death. Preoperative PV obstruction, palliative surgery, and residual PV obstruction were the predictors for reintervention (p < 0.05 for all).

The primary sutureless repair for the patients with mixed type TAPVD appeared to be safe and effective, resulting in no mortality and reintervention. There were nonsignificant trends toward improving survival and reintervention in the sutureless group. The patients who had sutureless repair and partially unrepaired PV revealed reasonable early and medium-term physiologic tolerance without need for reinterventions.