Computed tomography-based surgical strategy for total anomalous pulmonary venous connection

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Medical Imaging

Background:

• Total anomalous pulmonary venous connection (TAPVC) is a complex congenital heart defect requiring surgical repair.
• Surgical strategies for TAPVC have evolved, with a focus on improving outcomes, especially for patients with single ventricular heart (SVH).
• Computed tomographic angiography (CTA) has emerged as a valuable tool for pre-operative anatomical assessment.

Purpose of the Study:

• To evaluate the mid-term impact of CTA-based surgical planning on sutureless repair techniques for TAPVC.
• To clarify the anatomical indications for sutureless repair in TAPVC patients.
• To compare outcomes between two distinct surgical eras.

Main Methods:

• A retrospective analysis of 112 patients undergoing TAPVC repair between 1996 and 2018.
• Patients were divided into two eras: Era 1 (1996-2010) and Era 2 (2011-2018).
• CTA findings guided primary sutureless repair and branch pulmonary vein incision indications in Era 2, including patients with SVH.

Main Results:

• Five-year survival significantly improved from Era 1 to Era 2 for both biventricular heart (69% to 97%) and SVH (21% to 70%) patients.
• Post-repair pulmonary vein stenosis (PVS) occurred in 23% (Era 1) and 13% (Era 2) of biventricular heart patients, and 60% (Era 1) and 36% (Era 2) of SVH patients.
• Preoperative CTA was associated with improved survival and PVS-free survival in SVH patients. Reintervention for PVS showed an 88% 5-year survival.

Conclusions:

• CTA-based surgical strategies for TAPVC repair offer a significant survival benefit.
• While post-repair PVS can occur, aggressive reintervention strategies improve survival and vein patency.
• Sutureless repair, guided by CTA, is a viable and effective approach for TAPVC, particularly in complex cases.