title: Primary sutureless repair for "simple" total anomalous pulmonary venous connection: midterm results in a single institution.
abstract: OBJECTIVE
  We have previously reported the use of an atriopericardial or "sutureless" repair for surgical management of postoperative pulmonary vein stenosis. The potential of avoiding geometric distortion of pulmonary venous suture lines and preventing post-repair pulmonary vein stenosis encouraged us to extend the use of this technique for primary "simple" total anomalous pulmonary venous connection repair.
  
  
  METHODS
  Between January 1997 and July 2009, 57 consecutive patients (median age, 15 days; median weight, 3.4 kg) underwent sutureless or conventional total anomalous pulmonary venous connection repair.
  
  
  RESULTS
  Types of total anomalous pulmonary venous connection included supracardiac in 31 patients (54%), cardiac in 15 patients (26%), and infracardiac in 11 patients (19%). Median follow-up time was 2.9 years. Preoperative mean pulmonary vein score, a composite measure of stenosis in all 4 pulmonary veins, was 0.3/0-12, and vertical vein obstruction was found in 35 patients (61.4%). A primary sutureless repair was carried out in 21 patients (36.8%; supracardiac, n = 12; cardiac, n = 4; infracardiac, n = 5). The sutureless repair group had proportionally greater high-risk infracardiac total anomalous pulmonary venous connection (24% vs 16%, P = .05). Primary outcomes of death or reoperation for pulmonary vein stenosis and postoperative pulmonary vein scores (0.2 ± 0.7 vs 0.7 ± 1.7, P = .26) were not different between the techniques.
  
  
  CONCLUSIONS
  The sutureless repair group had proportionally more infracardiac total anomalous pulmonary venous connection and a higher rate of decline in postoperative right ventricular systolic pressure. Despite increased preoperative risk, no difference was observed in primary outcomes of death and reoperation in the conventional repair group.
authors: Division of Cardiac Surgery, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario.
authors: Bobby
authors: B
authors: Yanagawa
authors: Abdullah A
authors: AA
authors: Alghamdi
authors: Andreea
authors: A
authors: Dragulescu
authors: Nicola
authors: N
authors: Viola
authors: Osman O
authors: OO
authors: Al-Radi
authors: Luc L
authors: LL
authors: Mertens
authors: John G
authors: JG
authors: Coles
authors: Christopher A
authors: CA
authors: Caldarone
authors: Glen S
authors: GS
authors: Van Arsdell
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002675:Child, Preschool; D003251:Constriction, Pathologic; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D009864:Ontario; D011667:Pulmonary Veins / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging / Q000209:etiology; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012587:Scimitar Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome