title: Conventional and sutureless techniques for management of the pulmonary veins: Evolution of indications from postrepair pulmonary vein stenosis to primary pulmonary vein anomalies.
abstract: OBJECTIVE
  We have previously reported a limited but favorable experience with a novel sutureless technique for surgical management of postoperative pulmonary vein stenosis occurring after repair of total anomalous pulmonary venous drainage. Because this technique requires integrity of the retrocardiac space for hemostasis, extension of the technique to the primary repair of pulmonary vein anomalies requires evaluation. This analysis reviews our experience with the sutureless technique in patients with postrepair pulmonary vein stenosis, as well as our extension of the technique into primary repair of pulmonary vein anomalies.
  
  
  METHODS
  Retrospective univariable-multivariable analysis of all pulmonary vein stenosis procedures and sutureless pulmonary vein procedures over a 20-year period was performed. Cox proportional hazards modeling was used to identify variables associated with freedom from reoperation or death.
  
  
  RESULTS
  Sixty patients underwent 73 procedures, with pulmonary vein stenosis present in 65 procedures. The sutureless technique was used in 40 procedures. Freedom from reoperation or death at 5 years after the initial procedure was 49%. Unadjusted freedom from reoperation or death was greater with the sutureless technique for patients with postrepair pulmonary vein stenosis ( P = .04). By using multivariable analysis, a higher pulmonary vein stenosis score was associated with greater risk of reoperation or death. After adjustment, the sutureless repair was associated with a nonsignificant trend toward greater freedom from reoperation or death ( P = .12). Despite the absence of retrocardiac adhesions, operative mortality was not increased with the sutureless technique ( P = .64). Techniques to control bleeding (intrapleural hilar reapproximation) and improve exposure (inferior vena cava division) were identified.
  
  
  CONCLUSIONS
  The sutureless technique for postrepair pulmonary vein stenosis is associated with encouraging midterm results. Extension of the indications for the technique to primary repair appears safe with the development of simple intraoperative maneuvers.
authors.affiliation: Division of Cardiovascular Surgery and Cardiology at The Hospital for Sick Children and University of Toronto, Ontario, Canada.
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Yun
authors.forename: John G
authors.initials: JG
authors.lastname: Coles
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
authors.forename: Osman O
authors.initials: OO
authors.lastname: Al-Radi
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Wald
authors.forename: Vitor
authors.initials: V
authors.lastname: Guerra
authors.forename: Nilto C
authors.initials: NC
authors.lastname: de Oliveira
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Smallhorn
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
mesh_terms: D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013536:Suture Techniques; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods