Ann Pediatr Cardiol. 2026 Jul-Aug;19(4):389-395. doi: 10.4103/apc.apc_153_25. Epub 2026 Jul 31.
ABSTRACT
INTRODUCTION: Total anomalous pulmonary venous drainage (TAPVD) constitutes approximately 1.5% of all congenital heart defects. Surgical correction has traditionally been performed using the conventional technique; however, the sutureless approach has emerged as a recent alternative. This study aims to compare the surgical outcomes of the two techniques and to identify the variables influencing them.
SUBJECTS AND METHODS: This was a retrospective study over a 17-year period from 2007 to 2024. There were 55 patients of TAPVD: supracardiac ( n = 32), intracardiac ( n = 18), infracardiac ( n = 3), and mixed ( n = 2).
RESULTS: The median age of surgical intervention was 43 days (interquartile range [IQR]: 30-120), and the median weight was 3.40 kg (IQR: 3.00-4.30). Prematurity was present in 3 (5.5%) patients, 11 (19.6%) had preoperative pulmonary vein obstruction, 2 (3.6%) had atrial septal defect obstruction, and 23 (41.1%) had preoperative pulmonary hypertension. Twelve (21.4%) patients required preoperative intubation, 4 (7.1%) required inhaled nitric oxide, and 7 (12.5%) had hemodynamic instability/cardiopulmonary resuscitation (CPR). Surgical correction (supracardiac and infracardiac) was by conventional repair in 20 patients and sutureless in 15 patients. When comparing sutureless and conventional TAPVD repair techniques, no statistically significant differences were observed in rates of pulmonary hypertension crisis, hospital stay duration, noninvasive ventilation duration, postoperative infections, or chest re-exploration rates. Similarly, the incidence of pulmonary venous obstruction (PVO) and early mortality was comparable between the two groups. The predictors of early mortality were seen in patients with preoperative pulmonary hypertension (odds ratio [OR]: 5.63, P = 0.048), preoperative intubation (OR: 9.29, P = 0.008), and preoperative CPR (OR: 36.67, P ≤ 0.001). Incidence of postoperative low cardiac output syndrome was strongly associated with preoperative pulmonary hypertension (OR: 3.90, P = 0.02), while predictors of postoperative extracorporeal membrane oxygenation predominant in patients with preoperative PVO (OR: 24.57, P = 0.007), associated pulmonary abnormality (OR: 4.57, P = 0.031), and preoperative intubation (OR: 3.88, P = 0.05).
CONCLUSIONS: Early postoperative outcomes were found to be closely associated with the patients’ preoperative clinical status. Overall, in our cohort, no difference was seen between the conventional and sutureless technique of TAPVD repair. These findings may be influenced by the study’s limited sample size, potentially reducing its statistical power.
PMID:42603057 | PMC:PMC13475845 | DOI:10.4103/apc.apc_153_25
