The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center
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 veno...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:26266b5be59941c4b59cf4fc4c8b4a882021-11-12T04:55:11ZThe Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center2297-055X10.3389/fcvm.2021.775578https://doaj.org/article/26266b5be59941c4b59cf4fc4c8b4a882021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.775578/fullhttps://doaj.org/toc/2297-055XBackground: 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.Erchao JiErchao JiHailong QiuXiaobing LiuWen XieRong LiufuTao LiuJimei ChenShusheng WenXiaohua LiJianzheng CenJian ZhuangFrontiers Media S.A.articlecongenital heart diseasetotal anomalous pulmonary venous connectionpulmonary venous obstructionneonatesurvivalcentral venous pressureDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021) |
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DOAJ |
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EN |
| topic |
congenital heart disease total anomalous pulmonary venous connection pulmonary venous obstruction neonate survival central venous pressure Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
congenital heart disease total anomalous pulmonary venous connection pulmonary venous obstruction neonate survival central venous pressure Diseases of the circulatory (Cardiovascular) system RC666-701 Erchao Ji Erchao Ji Hailong Qiu Xiaobing Liu Wen Xie Rong Liufu Tao Liu Jimei Chen Shusheng Wen Xiaohua Li Jianzheng Cen Jian Zhuang The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center |
| description |
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. |
| format |
article |
| author |
Erchao Ji Erchao Ji Hailong Qiu Xiaobing Liu Wen Xie Rong Liufu Tao Liu Jimei Chen Shusheng Wen Xiaohua Li Jianzheng Cen Jian Zhuang |
| author_facet |
Erchao Ji Erchao Ji Hailong Qiu Xiaobing Liu Wen Xie Rong Liufu Tao Liu Jimei Chen Shusheng Wen Xiaohua Li Jianzheng Cen Jian Zhuang |
| author_sort |
Erchao Ji |
| title |
The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center |
| title_short |
The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center |
| title_full |
The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center |
| title_fullStr |
The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center |
| title_full_unstemmed |
The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center |
| title_sort |
outcomes of total anomalous pulmonary venous connection in neonates−10-year experience at a single center |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/26266b5be59941c4b59cf4fc4c8b4a88 |
| work_keys_str_mv |
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