The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates-10-Year Experience at a Single Center

Erchao Ji; Hailong Qiu; Xiaobing Liu; Wen Xie; Rong Liufu; Tao Liu; Jimei Chen; Shusheng Wen; Xiaohua Li; Jianzheng Cen; Jian Zhuang

doi:10.3389/fcvm.2021.775578

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates-10-Year Experience at a Single Center

Front Cardiovasc Med. 2021 Nov 12:8:775578. doi: 10.3389/fcvm.2021.775578. eCollection 2021.

Authors

Erchao Ji^{1

2}, Hailong Qiu¹, Xiaobing Liu¹, Wen Xie¹, Rong Liufu¹, Tao Liu³, Jimei Chen¹, Shusheng Wen¹, Xiaohua Li¹, Jianzheng Cen¹, Jian Zhuang¹

Affiliations

¹ Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² School of Medicine, South China University of Technology, Guangzhou, China.
³ Department of Biostatistics School of Public Health, Brown University, Providence, RI, United States.

Abstract

Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population. Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019. Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time (p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis (p = 0.001), prolonged CPB time (p < 0.001) and increased postoperative CVP (p = 0.007). In particular, mortality was significantly higher (p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques (p = 0.001) and decrease in deep hypothermic circulatory arrest (p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC (p = 0.037), preoperative acidosis (p = 0.001) and prolonged CPB time (p = 0.006). Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery.

Keywords: central venous pressure; congenital heart disease; neonate; pulmonary venous obstruction; survival; total anomalous pulmonary venous connection.