David Kalfa, Emre Belli, Emile Bacha, Virginie Lambert, Ducciodi Carlo, Martin Kostolny, Matej Nosal, Jurgen Horer, Jukka Salminen, Jean Rubay, Illya Yemets, Mark Hazekamp, Bohdan Maruszewski, George Sarris, Hakan Berggren, Tjark Ebels, Onur Baser, Francois Lacour-Gayet and the European Congenital Heart Surgeons Association
Morgan Stanley Children’s Hospital of New York-Presbyterian and Columbia University. Marie Lannelongue Hospital. Ospedale Pediatrico Bambino Gesù. Great Ormond Street Hospital. National Institute of Cardio-Vascular Diseases – Childrens Heart Center. German Heart Center. Hospital for Children and Adolescents and University of Helsinki. Saint-Luc Hospital. Ukrainian Childrens Cardiac Center. Leiden University Medical Center. Children’s Memorial Health Institute. Mitera Pediatric and Hygeia Hospital. The Queen Silvia Children’s Hospital. University Medical Center Groningen. Royal Hospital.
United States, France, Italy, Slovakia, United Kingdom, Germany, Finland, Belgium, Ukraine, Netherlands, Poland, Greece, Sweden and Oman
Journal of Thoracic and Cardiovascular Surgery
J Thorac Cardiovasc Surg 2018; 156: 278-286
DOI: 10.1016/j.jtcvs.2018.02.038
Abstract
Background: The optimal management and prognostic factors of postsurgical pulmonary vein stenosis remain controversial. We sought to determine current postsurgical pulmonary vein stenosis outcomes and prognostic factors in a multicentric study in the current era.
Methods: Seventy-five patients with postsurgical pulmonary vein stenosis who underwent 103 procedures in 14 European/North American centers (2000-2012) were included retrospectively. A specific pulmonary vein stenosis severity score was developed on the basis of the assessment of each pulmonary vein. End points were death, pulmonary vein reintervention, and restenosis. A univariate and multivariate risk analysis was performed.
Results: Some 76% of postsurgical pulmonary vein stenosis occurred after repair of a total anomalous pulmonary venous return. Sutureless repair was used in 42 of 103 procedures (41%), patch veinoplasty was used in 28 procedures (27%), and endarterectomy was used in 16 procedures (16%). Overall pulmonary vein restenosis, reintervention, and mortality occurred in 56% (n = 58/103), 49% (n = 50/103), and 27% (n = 20/75), respectively. Sutureless repair was associated with less restenosis (40% vs 67%; P = .007) and less reintervention (31% vs 61%; P = .003). Mortality after sutureless repair (20%; 7/35) tends to be lower than after nonsutureless repair (33%; 13/40) (P = .22). A high postoperative residual pulmonary vein stenosis score at the time of hospital discharge was an independent risk factor for restenosis (hazard ratio [HR], 1.55; P < 10-4), reintervention (HR, 1.33; P < 10-4), and mortality (HR, 1.37; P < 10-4). The sutureless technique was an independent protective factor against restenosis (HR, 0.27; P = .006).
Conclusions: Postsurgical pulmonary vein stenosis still has a guarded prognosis in the current era. The sutureless technique is an independent protective factor against restenosis. The severity of the residual disease evaluated by a new severity score is an independent risk factor for poor outcomes regardless of surgical technique.
Category
Segmental Pulmonary Venous Disease. Without a Focus on Pulmonary Hypertension
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes