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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.775578

DOI=10.3389/fcvm.2021.775578

ISSN=2297-055X

ABSTRACT=Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous connection (TAPVC) repair. However, the surgical repair of neonatal TAPVC remains associated with a high risk of mortality and postoperative pulmonary venous obstruction (PVO). We conducted this retrospective study to identify the risk factors associated with surgical outcomes in the neonatal population.
Methods: A retrospective review was conducted for all the 127 neonates who underwent operations for isolated TAPVC (from January 2009 to January 2019).
Results: Preoperative PVO occurred in 33 (26.0%) 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 time (CPB, p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 years 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 increased (p = 0.007) with a postoperative CVP > 8mmHg. With the widespread application of sutureless technique (p = 0.001) and the decrease of deep hypothermic circulatory arrest (p = 0.009) in recent five years, the postoperative mortality has 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 the postoperative mortality of neonatal TAPVC has dropped to 6.7% in the recent 5 years, it is still relatively high. The risk factors for postoperative death are preoperative acidosis, prolonged CPB time and increased postoperative CVP. And the mortality of neonates with an average CVP > 8mmHg at 24 hours after surgery was significantly higher.