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Predictive Factors for Prolonged Ventilatory Support in Infants Undergoing Total Anomalous Pulmonary Venous

Chun-Xiang Li1, Xiao-Lei Gong1, Li-Min Zhu1

  • 1Department of Cardiac Intensive Care Unit, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 200127 Shanghai, China.

Reviews in Cardiovascular Medicine
|November 10, 2025
PubMed

Insights

Infants undergoing total anomalous pulmonary venous connection (TAPVC) repair with low weight, preoperative obstruction, or extended bypass times face prolonged recovery. Identifying these risk factors can optimize care for better outcomes.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Critical Care Medicine

Background:

  • Total anomalous pulmonary venous connection (TAPVC) is a serious congenital heart defect requiring surgical intervention.
  • Postoperative complications, including prolonged mechanical ventilation and mortality, are significant risks following TAPVC repair.
  • Identifying factors associated with extended recovery is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine perioperative risk factors associated with prolonged ventilatory support in infants undergoing surgical repair of TAPVC.
  • To analyze the impact of specific clinical and surgical variables on postoperative recovery duration.

Main Methods:

  • Retrospective analysis of 323 infants under 6 months who underwent TAPVC repair (January 2017-December 2022).
  • Patients categorized into prolonged (Group A) and normal (Group B) recovery based on ventilatory support duration (75th percentile cutoff).
  • Comparison of perioperative characteristics using statistical methods, including multivariate logistic regression.

Main Results:

  • Prolonged recovery (Group A) was associated with significantly longer mechanical ventilation and ICU stays compared to normal recovery (Group B).
  • Independent risk factors for prolonged recovery included: low weight-for-age Z score (<-2), preoperative pulmonary venous obstruction, emergency surgery, extended cardiopulmonary bypass and aortic cross-clamp times, diaphragmatic injury, and a high PV/LVDD ratio.
  • These factors significantly increased the likelihood of delayed recovery, with odds ratios ranging from 5.3 to 9.8.

Conclusions:

  • Infants with specific risk factors (low weight, preoperative obstruction, emergency surgery, prolonged bypass/cross-clamp times, diaphragmatic injury, high PV/LVDD ratio) are at higher risk for prolonged recovery after TAPVC repair.
  • Early identification of these high-risk infants is essential for targeted perioperative management.
  • Optimizing management strategies for these infants can lead to improved postoperative outcomes and reduced complications.
Abstract

Keywords:
left ventricular end diastolic dimensionprolonged recoverypulmonary venous flowtotal anomalous pulmonary venous connection

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