Application and evaluation of modified pericardial oblique sinus approach in total anomalous pulmonary venous connection in neonates_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Junfei , CAI Xiaowei , LI Xiaohua , ZHUANG Jian , WEN Shusheng , CENG Jianzheng , XU Gang , CUI Hujun ,  CHEN Jimei

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;

Corresponding author：

CHEN Jimei, Email: jimei_1965@outlook.com

Keywords：

Modified pericardial oblique sinus pathway; neonates; total anomalous pulmonary venous connection

DOI：

10.7507/1007-4848.201904058

Video：

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Objective To analyze the use of modified pericardial oblique sinus approach in surgical repair for total anomalous pulmonary venous connection in neonates. Methods Between May 2005 and December 2015, 67 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. The patients are divided into three groups according to the different approaches including a sulcus approach group (6 patients), a superior approach group (14 patients), and a modified pericardial oblique sinus approach group (47 patients). There were 53 males and 14 females at median age of 12.5 (7.0, 20.5) d. Results The time of cardiopulmonary bypass [88 (80.0, 107.0) min vs. 135 (121.0, 157.0) min, P<0.05] and aortic cross clamping of the modified pericardial oblique sinus approach group was significantly shorter than that of the sulcus approach group [45 (39.0, 53.0) min vs. 80 (73.0, 85.0) min, P<0.05]. Perioperative mortality (2.1% vs. 28.6%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the superior approach group. The long-term mortality (4.3% vs. 60.0%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group or the superior approach group . The rate of pulmonary venous stenosis was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group (2.1% vs. 50.0%, P<0.05) or superior approach group (2.1% vs. 35.7%, P<0.05). Conclusions In surgical correction of neonatal supracardiac and infracardiac total anomalous pulmonary venous, compared with the traditional surgical approach, the modified pericardial oblique sinus pathway can provide excellent surgical space and has a good surgical prognosis.

Citation： ZHAO Junfei, CAI Xiaowei, LI Xiaohua, ZHUANG Jian, WEN Shusheng, CENG Jianzheng, XU Gang, CUI Hujun, CHEN Jimei. Application and evaluation of modified pericardial oblique sinus approach in total anomalous pulmonary venous connection in neonates. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(10): 952-957. doi: 10.7507/1007-4848.201904058 Copy

1.	Michielon G, Di Donato RM, Pasquini L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg, 2002, 22(2): 184-191.
2.	Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
3.	Yong MS, d’Udekem Y, Robertson T, et al. Outcomes of surgery for simple total anomalous pulmonary venous drainage in neonates. Ann Thorac Surg, 2011, 91(6): 1921-1927.
4.	Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg, 2005, 79(2): 596-606.
5.	Herlong JR, Jaggers JJ, Ungerleider RM. Congenital Heart Surgery Nomenclature and Database Project: pulmonary venous anomalies. Ann Thorac Surg, 2000, 69(4 Suppl): S56-S69.
6.	Ehrenhaft JL, Theilen EO, Lawrence MS. The surgical treatment of partial and total anomalous pulmonary venous connections. Ann Surg, 1958, 148(2): 249-258.
7.	Azakie A, Lavrsen MJ, Johnson NC, et al. Early outcomes of primary sutureless repair of the pulmonary veins. Ann Thorac Surg, 2011, 92(2): 666-671.
8.	Honjo O, Atlin CR, Hamilton BC, et al. Primary sutureless repair for infants with mixed total anomalous pulmonary venous drainage. Ann Thorac Surg, 2010, 90(3): 862-868.
9.	Matsuhisa H, Oshima Y, Maruo A, et al. Primary sutureless repair and anterior translocation of the atrial septum for cardiac total anomalous pulmonary venous connection. Ann Thorac Surg, 2013, 95(2): 729-730.
10.	Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
11.	Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome. Eur J Cardiothorac Surg, 2003, 24(1): 28-36.
12.	Kirshbom PM, Myung RJ, Gaynor JW, et al. Preoperative pulmonary venous obstruction affects long-term outcome for survivors of total anomalous pulmonary venous connection repair. Ann Thorac Surg, 2002, 74(5): 1616-1620.
13.	Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest, 1957, 6(1): 44-64.
14.	Tucker BL, Lindesmith GG, Stiles QR, et al. The superior approach for correction of the supracadiac type of total anomalous pulmonary venous return. Ann Thorac Surg, 1976, 22(4): 374-377.
15.	Le Bret E, Roubertie F, Belli E, et al. Supracardiac total anomalous pulmonary venous connection: the transaortopulmonary approach. Ann Thorac Surg, 2009, 88(3): e27-e28.
16.	Cobanoglu A, Menashe VD. Total anomalous pulmonary venous connection in neonates and young infants: repair in the current era. Ann Thorac Surg, 1993, 55(1): 43-48.

1. Michielon G, Di Donato RM, Pasquini L, et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg, 2002, 22(2): 184-191.
2. Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
3. Yong MS, d’Udekem Y, Robertson T, et al. Outcomes of surgery for simple total anomalous pulmonary venous drainage in neonates. Ann Thorac Surg, 2011, 91(6): 1921-1927.
4. Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg, 2005, 79(2): 596-606.
5. Herlong JR, Jaggers JJ, Ungerleider RM. Congenital Heart Surgery Nomenclature and Database Project: pulmonary venous anomalies. Ann Thorac Surg, 2000, 69(4 Suppl): S56-S69.
6. Ehrenhaft JL, Theilen EO, Lawrence MS. The surgical treatment of partial and total anomalous pulmonary venous connections. Ann Surg, 1958, 148(2): 249-258.
7. Azakie A, Lavrsen MJ, Johnson NC, et al. Early outcomes of primary sutureless repair of the pulmonary veins. Ann Thorac Surg, 2011, 92(2): 666-671.
8. Honjo O, Atlin CR, Hamilton BC, et al. Primary sutureless repair for infants with mixed total anomalous pulmonary venous drainage. Ann Thorac Surg, 2010, 90(3): 862-868.
9. Matsuhisa H, Oshima Y, Maruo A, et al. Primary sutureless repair and anterior translocation of the atrial septum for cardiac total anomalous pulmonary venous connection. Ann Thorac Surg, 2013, 95(2): 729-730.
10. Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
11. Ricci M, Elliott M, Cohen GA, et al. Management of pulmonary venous obstruction after correction of TAPVC: risk factors for adverse outcome. Eur J Cardiothorac Surg, 2003, 24(1): 28-36.
12. Kirshbom PM, Myung RJ, Gaynor JW, et al. Preoperative pulmonary venous obstruction affects long-term outcome for survivors of total anomalous pulmonary venous connection repair. Ann Thorac Surg, 2002, 74(5): 1616-1620.
13. Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest, 1957, 6(1): 44-64.
14. Tucker BL, Lindesmith GG, Stiles QR, et al. The superior approach for correction of the supracadiac type of total anomalous pulmonary venous return. Ann Thorac Surg, 1976, 22(4): 374-377.
15. Le Bret E, Roubertie F, Belli E, et al. Supracardiac total anomalous pulmonary venous connection: the transaortopulmonary approach. Ann Thorac Surg, 2009, 88(3): e27-e28.
16. Cobanoglu A, Menashe VD. Total anomalous pulmonary venous connection in neonates and young infants: repair in the current era. Ann Thorac Surg, 1993, 55(1): 43-48.

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Application and evaluation of modified pericardial oblique sinus approach in total anomalous pulmonary venous connection in neonates

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