Total Anomalous Pulmonary Venous Connection: A 40 years' Experience Analysis

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Congenital Heart Disease

Background:

• Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart defect with historically high morbidity and mortality.
• Conventional surgical techniques are the mainstay for TAPVC repair.

Purpose of the Study:

• To evaluate the mid-term and long-term results of conventional surgical techniques for TAPVC.
• To identify risk factors associated with mortality and late complications after TAPVC repair.

Main Methods:

• Retrospective analysis of 180 patients operated on for simple TAPVC between 1973 and 2014.
• Inclusion of various TAPVC anatomical types: supracardiac, intracardiac, infracardiac, and mixed.
• Multivariate analysis to identify significant risk factors for mortality and late complications.

Main Results:

• Overall mortality was 27.1%, with a significant decrease in early deaths over time (42.1% in the 1970s to 7.4% after 2010).
• Risk factors for death included earlier era of intervention, preoperative pulmonary hypertension, acidosis, and cardiopulmonary bypass time.
• Long-term follow-up showed 84.7% of patients were asymptomatic, with excellent survival rates.

Conclusions:

• The prognosis for TAPVC repair using conventional methods has markedly improved, demonstrating excellent long-term outcomes.
• Careful preoperative assessment is crucial for optimizing surgical results in TAPVC patients.
• Mixed TAPVC forms and longer aortic cross-clamp times were associated with increased late complications.