心下型完全性肺静脉异位引流术后预后分析:单中心经验

Surgical prognosis for infracardiac total anomalous pulmonary venous connection:experience in a single institution

目的总结心下型完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)患者手术治疗经验,探讨死亡和术后并发症的危险因素。方法回顾性研究纳入2009年2月至2022年12月期间74例接受手术的TAPVC患者,其中常规手术28例,sutureless手术46例。回顾患者临床数据,评估死亡和术后肺静脉梗阻(pulmonary venous obstruction,PVO)的危险因素。应用Kaplan-Meier曲线和Cox回归分析总体生存率。使用累积发生率曲线评估术后PVO。结果早期死亡4例,晚期死亡3例,总体生存率为90.5%(67/74)。12例患者出现术后PVO。中位随访时间39.4个月。Sutureless组的总体生存率高于传统手术组(P=0.003)。传统手术组术后PVO的发生率高于sutureless组(P=0.008)。再发PVO的危险因素包括较长的体外循环时间、较高的结合胆红素以及手术修复前国际标准化比值的升高。结论对于心下型TAPVC患者,Sutureless手术和传统手术均可获得可接受的术后结果。Sutureless手术生存率更高,肺静脉和吻合口再狭窄发生率更低。

Objective This study aimed at reviewing surgical experiences and exploring risk factors for mortality and postoperative complications in patients with infracardiac total anomalous pulmonary venous connection(TAPVC).Methods This retrospective study included 74 infants who underwent conventional repair(28 cases)and sutureless repair(46 cases)in one hospital from February 2009 to December 2022.Clinical data were reviewed to assess risk factors for mortality and postoperative pulmonary venous obstruction(PVO).Kaplan-Meier curves and cox regressions were applied to analyze the overall survival.Cumulative incidence curve and sub-distribution hazard models were used to evaluate postoperative PVO.Results There were 4 early deaths and 3 late deaths,and the overall survival rate was 90.5%.A total of 12 patients complicated postoperative PVO.The median follow-up was 39.4 months(IQR:13.3 to 73.7 months).The overall survival rate was higher in the sutureless group than the conventional group(P=0.003).The incidence rate of postoperative PVO in the conventional group was higher than that in the sutureless group(P=0.008).Risk factors for recurrent PVO included longer cardiopulmonary bypass time,the increase of direct bilirubin level and international normalized ratio level before surgical repair.Conclusion Both sutureless and conventional repairs for patients with infracardiac TAPVC can achieve acceptable postoperative outcomes.Sutureless repair has a higher survival rate and a lower incidence of re-stenosis in pulmonary veins and anastomosis.