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Predictors of mortality and morbidity in total anomalous pulmonary venous connection with biventricular physiology: A 10-year Indian single centre experience of 492 patients


1 Department of Cardiothoracic Surgery, Star Hospitals, Hyderabad, Telangana, India
2 Department of Anesthesiology, Star Hospitals, Hyderabad, Telangana, India
3 Department of Paediatrics, Star Hospitals, Hyderabad, Telangana, India
4 Department of Paediatric Cardiology, Star Hospitals, Hyderabad, Telangana, India

Correspondence Address:
Dr. Sairam Palaparthi
Flat No 302, Nandi Residency, Anand Nagar Colony, Near SBI ATM, Khairatabad, Hyderabad - 500 004, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.apc_104_21

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Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 229-237

 

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Background : Surgical correction of total anomalous pulmonary venous connection (TAPVC) remains associated with significant mortality despite advances in intra-operative and postoperative management. We retrospectively analyzed 492 consecutive TAPVC patients with biventricular physiology, who were operated at our centre, with regard to predictors of mortality, morbidity, and intermediate-term outcomes. Materials and Methods : A total of 492 TAPVC patients with biventricular physiology were operated at our centre from August 2009 to November 2019. Their medical records were reviewed and were followed up during March-April 2020 for any symptoms of cardiac disease. Results : Of 492, 302 (61.38%) were healthy at follow-up, 29 (5.89%) had postoperative mortality, 23 (4.67%) had mortality during the follow-up period, and 138 (28.05%) were lost to follow up. Age <1 month and weight <2.5 kg were associated with higher mortality with odds ratios (OR) of 6.37 and 5.56, respectively. There was no difference in mortality in different types of TAPVC. Obstructed TAPVC was associated with higher mortality with OR of 3.05. Acute kidney injury requiring peritoneal dialysis and sepsis were associated with higher mortality with ORs of 10.17 and 3.29, respectively. All follow-up mortality occurred in <1 year from the index operation. Anastomotic gradients were significantly higher in patients who died. Conclusions : Although peri-operative TAPVC mortality has reduced, mortality on follow-up continues to occur and is partly due to the obstruction of pulmonary venous pathway. Meticulous follow-up holds the key in further reducing the mortality. Larger studies are needed for the identification of risk factors for pulmonary venous obstruction and its preventive strategies.






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1 Department of Cardiothoracic Surgery, Star Hospitals, Hyderabad, Telangana, India
2 Department of Anesthesiology, Star Hospitals, Hyderabad, Telangana, India
3 Department of Paediatrics, Star Hospitals, Hyderabad, Telangana, India
4 Department of Paediatric Cardiology, Star Hospitals, Hyderabad, Telangana, India

Correspondence Address:
Dr. Sairam Palaparthi
Flat No 302, Nandi Residency, Anand Nagar Colony, Near SBI ATM, Khairatabad, Hyderabad - 500 004, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.apc_104_21

Rights and Permissions

Background : Surgical correction of total anomalous pulmonary venous connection (TAPVC) remains associated with significant mortality despite advances in intra-operative and postoperative management. We retrospectively analyzed 492 consecutive TAPVC patients with biventricular physiology, who were operated at our centre, with regard to predictors of mortality, morbidity, and intermediate-term outcomes. Materials and Methods : A total of 492 TAPVC patients with biventricular physiology were operated at our centre from August 2009 to November 2019. Their medical records were reviewed and were followed up during March-April 2020 for any symptoms of cardiac disease. Results : Of 492, 302 (61.38%) were healthy at follow-up, 29 (5.89%) had postoperative mortality, 23 (4.67%) had mortality during the follow-up period, and 138 (28.05%) were lost to follow up. Age <1 month and weight <2.5 kg were associated with higher mortality with odds ratios (OR) of 6.37 and 5.56, respectively. There was no difference in mortality in different types of TAPVC. Obstructed TAPVC was associated with higher mortality with OR of 3.05. Acute kidney injury requiring peritoneal dialysis and sepsis were associated with higher mortality with ORs of 10.17 and 3.29, respectively. All follow-up mortality occurred in <1 year from the index operation. Anastomotic gradients were significantly higher in patients who died. Conclusions : Although peri-operative TAPVC mortality has reduced, mortality on follow-up continues to occur and is partly due to the obstruction of pulmonary venous pathway. Meticulous follow-up holds the key in further reducing the mortality. Larger studies are needed for the identification of risk factors for pulmonary venous obstruction and its preventive strategies.






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