PDF(Pubmed)
Abstract：
Total anomalous pulmonary venous connection (TAPVC) is a rare congenital defect where pulmonary venous plexus fails to connect with the left atrium (LA). Surgical repair is the primary treatment for TAPVC, but factors influencing outcomes are not fully understood. This study investigates the early outcomes of surgical repair for TAPVC and associated factors. A retrospective cohort analysis was conducted on TAPVC patients who underwent surgical repair between 2012 and 2022. Data were collected from medical records and supplemented with phone call validation. Demographic characteristics, surgical data, diagnostic tests, and outcomes were analyzed. Statistical analysis included chi-square, t-tests, and multivariate logistic regression using SPSS. A total of 88 patients underwent surgical repair for TAPVC, resulting in a mortality rate of 21.6%. Weight and bypass time were significantly associated with patient survival. Female patients had a higher likelihood of death. The anatomic type did not significantly influence mortality. Patients with pulmonary venous obstruction (PVO) experienced a higher mortality rate. Notably, ligation of the vertical vein in supracardiac and infracardiac types was associated with lower mortality. In conclusion, our study identifies several key factors contributing to higher mortality rates following TAPVC surgery, including low weight, female gender, prolonged bypass time, and preoperative vein obstruction. Highlighting the significance of surgical technique, particularly the sutureless approach, we advocate for its meticulous consideration to achieve improved outcomes. Furthermore, our findings indicate a potential decrease in mortality associated with vertical vein ligation, which may mitigate the risk of post-repair heart failure. We suggest further rigorous studies to gain comprehensive insights into TAPVC surgical interventions.
摘要：
完全异常肺静脉连接（TAPVC）是一种罕见的先天性缺陷，其中肺静脉丛无法与左心房（LA）连接。手术修复是TAPVC的主要治疗方法,但影响结果的因素尚未完全了解。本研究调查了TAPVC手术修复的早期结果及相关因素。对2012年至2022年接受手术修复的TAPVC患者进行回顾性队列分析。从医疗记录中收集数据，并补充电话验证。人口特征，手术数据,诊断测试,并对结果进行了分析。统计分析包括卡方，t检验,并使用SPSS进行多变量逻辑回归。共有88例患者接受了TAPVC手术修复，导致21.6%的死亡率。体重和旁路时间与患者生存率显著相关。女性患者死亡的可能性更高。解剖类型对死亡率没有显著影响。肺静脉阻塞（PVO）患者的死亡率更高。值得注意的是,心上型和心下型的垂直静脉结扎术与较低的死亡率相关。总之,我们的研究确定了导致TAPVC手术后死亡率较高的几个关键因素，包括低重量，女性性别,延长旁路时间，术前静脉阻塞。突出了外科技术的重要性，特别是无情的方法，我们主张对其进行细致的考虑，以实现更好的结果。此外，我们的研究结果表明，与垂直静脉结扎相关的死亡率可能会降低，这可能会降低修复后心力衰竭的风险。我们建议进一步严格的研究，以获得对TAPVC手术干预的全面见解。
