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Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair
Radoslaw Jaworski1, Andrzej Kansy2, Joanna Friedman-Gruszczynska2
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland.
Insights
Surgical repair of total anomalous pulmonary venous connection (TAPVC) in children has improved, but significant risks remain. Negative prognostic factors include specific TAPVC types and single ventricle physiology, while normal heart physiology shows good outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Outcomes Research
Background:
- Surgical repair of total anomalous pulmonary venous connection (TAPVC) has seen improvements.
- Significant morbidity and mortality persist despite advances in TAPVC treatment.
Purpose of the Study:
- To evaluate early and long-term outcomes of surgical TAPVC treatment in children.
- To identify risk factors influencing mortality after TAPVC repair.
Main Methods:
- Retrospective analysis of 83 pediatric patients undergoing TAPVC surgery (2006-2016).
- Inclusion of diagnostic, surgical, and follow-up data.
- Performance of survival analysis, risk factor assessment, echocardiography, and electrocardiography.
Main Results:
- Hospital mortality was 8.4% (7 deaths), and late mortality was 10.8% (9 deaths).
- Five-year survival rate was 78.4% with a mean follow-up of 5.5 years.
- Independent mortality risk factors included Type I TAPVC, single ventricle physiology, delayed surgery, and postoperative complications.
Conclusions:
- Single ventricle physiology and supracardiac TAPVC are potential negative prognostic factors.
- Normal heart physiology is associated with favorable post-repair results.
- Cardiac arrhythmias are a noted complication, and overall morbidity/mortality remain significant.
Abstract:
Background and Objectives: Over the years, surgical repair of total anomalous pulmonary venous connection (TAPVC) outcomes have improved, however, morbidity and mortality still remain significant. This study aims to assess the early and long-term outcomes of surgical treatment of TAPVC children, operated on between 2006 and 2016, in one pediatric center in Poland. Materials and Methods: Diagnostics, surgical treatment, and follow-up data from 83 patients were collected. In addition, survival and risk factor analyses, control echocardiographic, and electrocardiographic examinations were performed. Results: In the analyzed group (n = 83), there were seven hospital deaths (within 30 days after the operation) (8.4%) and nine late deaths (10.8%). The mean follow-up time was 5.5 years, and, for patients who survived, it was 7.1 years. The mean survival time in patients with completed follow-up (n = 70) was 10.3 years; the overall five-year survival rate was 78.4%. Independent mortality risk factors were type I TAPVC, single ventricle physiology, time from admission to operation, intensive care unit stay, postoperative hospital stay, and temporary kidney insufficiency requiring dialysis. Conclusions: The presence of single ventricle physiology and the supracardiac subtype of TAPVC might be negative prognostic factors, while normal heart physiology presents with good post-repair results. This study indicates that cardiac arrhythmias may occur. Morbidity and mortality, related to surgical TAPVC correction, still remain significant.
