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Midterm results and risk factors of functional single ventricles with extracardiac total anomalous pulmonary venous connection

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Abstract

Objectives

To evaluate the clinical outcomes of surgical repair of an extracardiac total anomalous pulmonary venous connection (TAPVC) in a functional single-ventricle (f-SV) strategy.

Methods

This was a retrospective analysis of 48 consecutive cases of extracardiac TAPVC repair, from 1998 to 2015. Demographic and clinical variables were as follows: median age, 24 (range 0–744) days; median weight, 3.1 (range 2.0–9.6) kg; type of TAPVC—supracardiac, 21 patients, infracardiac, 8, and mixed, 19; right atrial isomerism, 45 patients; pulmonary atresia, 24 patients; and obstructed TAPVC, 30 patients. Concomitant procedures included systemic-to-pulmonary shunting in 15 patients, pulmonary artery banding in 12, ventricle-to-pulmonary artery shunting in 2, a Norwood procedure in one, a bidirectional Glenn procedure in 16, and a Fontan procedure in 1.

Results

The 1- and 5-year cumulative survival rates were 66.0% and 58.0%, respectively. Of the 28 survivors, 22 (78.6%) underwent Fontan completion and 4 (14.3%) a bidirectional Glenn procedure, and 1 (3.6%) was awaiting a bidirectional Glenn procedure. Recurrent pulmonary venous stenosis (PVS) was observed in 17 patients, with a 1- and 5-year rates of freedom from recurrent PVS 59.8% and 53.5%, respectively. Of the 20 post-operative deaths, only 4 were PVS related. Only pre-operative pulmonary atresia was identified as an independent risk factor of mortality after TAPVC repair.

Conclusions

The midterm surgical outcomes of f-SV with extracardiac TAPVC were acceptable. Moreover, among survivors, Fontan completion can be sufficiently expected. Further improvement, with the development of a comprehensive treatment strategy, is required for this patient group.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan

    Mikio Sugano, Masaya Murata, Yujiro Ide, Hiroki Ito, Kazuyoshi Kanno, Kenta Imai, Motonori Ishidou, Ryohei Fukuba & Kisaburou Sakamoto

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  1. Mikio Sugano
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  2. Masaya Murata
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  3. Yujiro Ide
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  4. Hiroki Ito
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  5. Kazuyoshi Kanno
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  6. Kenta Imai
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  7. Motonori Ishidou
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  8. Ryohei Fukuba
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  9. Kisaburou Sakamoto
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Correspondence to Kisaburou Sakamoto.

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Sugano, M., Murata, M., Ide, Y. et al. Midterm results and risk factors of functional single ventricles with extracardiac total anomalous pulmonary venous connection. Gen Thorac Cardiovasc Surg 67, 941–948 (2019). https://doi.org/10.1007/s11748-019-01141-3

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  • DOI: https://doi.org/10.1007/s11748-019-01141-3

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