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Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era

European Congenital Heart Surg, Jul-2018, In : JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. 156, 1, p. 278-286 9 p.

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  • Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era

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  • European Congenital Heart Surg

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

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.

Original languageEnglish
Pages (from-to)278-286
Number of pages9
JournalJOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume156
Issue number1
Publication statusPublished - Jul-2018

    Keywords

  • congenital heart disease, outcomes, pulmonary vein stenosis, sutureless repair, VENOUS CONNECTION, SURGICAL REPAIR, SINGLE-INSTITUTION, SUTURELESS REPAIR, IN-SITU, MANAGEMENT, PERICARDIUM, STRATEGIES, SEVERITY, SURVIVAL

ID: 75521617