title: Early outcomes of primary sutureless repair of the pulmonary veins.
abstract: BACKGROUND
  The "sutureless" repair technique has improved outcomes for post-repair pulmonary vein (PV) stenosis. The purpose of this study is to determine the early outcomes of primary sutureless repair of pulmonary venoocclusive disease in infants with congenital PV stenosis-hypoplasia or PVs at high risk for progressive stenosis.
  
  
  METHODS
  This is a retrospective review of infants who had primary sutureless repair of the PVs from October 2002 to April 2010.
  
  
  RESULTS
  Twenty-five infants had primary sutureless repair of the PVs. Eighteen infants had total anomalous pulmonary venous return; 14 with obstruction, 10 with heterotaxy syndrome, and 9 with univentricular anatomy. Seven infants had congenital PV stenosis. There were 24 perioperative survivors (96%; 95% confidence interval [CI], 75% to 99%) and 2 late deaths from extracardiac causes. Follow-up was available on 21 out of 22 survivors at a median duration of 34 months (range, 9 to 100 months). Persistence-recurrence of PV stenosis occurred in 3 veins (3%) of 2 infants (8%). On follow-up echocardiography, right ventricular systolic pressure was normal in 13 out of 14 infants with a biventricular heart and 60% of systemic blood pressure in 1 infant. Kaplan-Meier 1-year cumulative survival was 88% (95% CI, 66% to 96%). Kaplan-Meier cumulative disease-free survival was 96% (95% CI, 75% to 99%) at 30 days and 84% (95% CI, 58% to 95%) at 1 year. By Cox proportional hazards, age, univentricular anatomy, and atrial isomerism-heterotaxy syndrome were not associated with an increased risk of death or persistence-recurrence. One-year disease-free survival was lower in infants with prematurity (p=0.0055) and low birth weight (p=0.0011).
  
  
  CONCLUSIONS
  Primary sutureless repair is a feasible, safe, and relatively effective method of addressing congenital PV stenosis and (or) high-risk PVs, particularly in infants with single ventricle anatomy and (or) heterotaxy syndrome.
authors.affiliation: UCSF Benioff Children's Hospital, Department of Surgery, University of California-San Francisco, San Francisco, California 94143, USA. tony.azakie@ucsfmedctr.org
authors.forename: Anthony
authors.initials: A
authors.lastname: Azakie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lavrsen
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Johnson
authors.forename: Anil
authors.initials: A
authors.lastname: Sapru
mesh_terms: D003238:Connective Tissue / Q000601:surgery; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D010496:Pericardium / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery; D011668:Pulmonary Veno-Occlusive Disease / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012587:Scimitar Syndrome / Q000401:mortality / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques