title: Primary pulmonary vein stenosis: the impact of sutureless repair on survival.
abstract: BACKGROUND
  Primary pulmonary vein stenosis is often associated with relentless restenosis and early death. During the last 2 decades, we have developed a sutureless repair to improve prognosis.
  
  
  METHODS
  Hospital records for patients undergoing repair of primary pulmonary vein stenosis from 1989 to 2008 were reviewed. Pulmonary vein stenosis was quantified with a pulmonary vein stenosis score. Survival was determined by Kaplan-Meier analysis.
  
  
  RESULTS
  Twenty-three patients underwent surgical repair. Mean ages at diagnosis and index repair were 23.3 ± 45.6 and 24.1 ± 40.9 months, respectively. Systemic or suprasystemic pulmonary artery pressures were present in 13 of 18 patients (72%). Seven (31%) had single-ventricle circulation. A sutureless technique was used in 19 of 23 cases (83%). Other types of repair were used in 4 of 23 (17%). There were 11 recorded deaths (47%). Survivals were 64%, 47%, and 31% at 1, 5, and 10 years, respectively. Five patients (22%) required 1 reintervention. Surgical repair significantly reduced the total pulmonary vein stenosis score (5.6 ± 2.10 before repair, 2.6 ± 2.72 after repair, P = .0057). The preoperative pulmonary vein stenosis score was the only independent predictor of mortality (hazard ratio, 1.732; P < .01). A preoperative pulmonary vein stenosis score of greater than 4 was a poor prognostic indicator (area under the curve, 0.83).
  
  
  CONCLUSIONS
  Mortality and restenosis rates remained high despite the adoption of a sutureless technique. A preoperative pulmonary vein stenosis score of greater than 4 was a strong predictor of poor prognosis.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Southampton University Hospital, Southampton, United Kingdom. nicola.viola@suht.swest.nhs.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Viola
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Alghamdi
authors.forename: Donald G
authors.initials: DG
authors.lastname: Perrin
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wilson
authors.forename: John G
authors.initials: JG
authors.lastname: Coles
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome