A modified sutureless technique treating total anomalous pulmonary venous connection / 中国胸心血管外科临床杂志

@#Objective    To introduce a modified sutureless technique and its surgical results in the treatment of total anomalous pulmonary venous connection (TAPVC). Methods    Clinical data of 11 patients with TAPVC who underwent the modified sutureless technique treatment from 2014 to 2019 in our center were retrospectively analyzed, including 4 males and 7 females. The median surgical age was 1.4 (0.3, 27.0) months. The median weight was 4.3 (3.5, 8.5) kg. Six (54.5%) patients were of supracardiac subtype, and five (45.5%) patients were of infracardiac subtype. Five (45.5%) patients had preoperative severe pulmonary hypertension, and three (27.3%) patients had preoperative pulmonary vein obstruction. The surgical results were compared with those of 10 patients treated with conventional surgical technique. Results    The median follow-up was 12 (range, 1-65) months. During the follow-up, no death or postoperative pulmonary vein obstruction occurred in the modified sutureless technique group. The perioperative data and relief of re-obstruction were superior in the modified sutureless technique group, but the difference was not statistically significant (P>0.05). The postoperative survival of the the modified sutureless technique group was better than that of the traditional surgery group (P=0.049). Conclusion    The modified sutureless technique which includes partial suture and then incising, and eversion of pulmonary vein incision, is a safe and reliable method for the treatment of TAPVC with satisfactory short-term results.

A Case of Left Ventricular Free Wall Rupture with Suspected Posterior Papillary Muscle Necrosis / 日本心臓血管外科学会雑誌

We report a case of arbitrary delayed surgical repair for left ventricular free wall rupture (LVFWR) after acute myocardial infarction with suspected posterior papillary muscle necrosis. The case was a 67-year-old woman who had chest and back pain in the morning, and relapsed in the evening, and was urgently transported. She had an acute lateral wall myocardial infarction on an electrocardiogram and pericardial effusion on transthoracic echocardiography (TTE). She was found to have an obstruction at the origin of the left circumflex branch on coronary angiography. TTE showed low-intensity findings on the head of the posterior papillary muscle, suggesting necrosis of the papillary muscle. For LVFWR, conservative treatment was prioritized and IABP (intra-aortic balloon pumping) management was performed for the purpose of reducing after load because there was concern about papillary muscle rupture (PMR) due to cardiac manipulation and because it was an oozing type and did not disrupt respiratory of circulatory dynamics. On the 7th day after the onset, TTE showed improvement in echo-luminance of the posterior papillary muscle head and gradual increase in pericardial fluid, and a non-suture procedure was performed. She withdrew from the IABP on the third day after surgery and was discharged home on the 12th day.

Surgical treatment of infracardiac total anomalous pulmonary venous connection: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To compare the outcomes of sutureless technique and conventional technique in the surgical repair for infracardiac total anomalous pulmonary venous connection (TAPVC). Methods    The clinical data of 46 consecutive patients with infracardiac TAPVC undergoing surgical repair in our hospital between June 2014 and April 2019 were retrospectively analyzed. Patients with combined congenital cardiac anomalies such as single ventricle and tetralogy of Fallot were excluded. Patients were divided into a conventional technique group and a sutureless technique group according to the surgical techniques. There were 35 patients in the conventional technique group, including 28 males (80.0%) and 7 females (20.0%) with a median age of 21 (8, 42) d and a median weight of 3.6 (3.0, 4.0) kg. There were 11 patients in the sutureless technique group, including 8 males (72.7%) and 3 females (27.3%) with a median age of 14 (6, 22) d and a median weight of 3.5 (2.9, 3.6) kg. The curative effect of the two groups was compared. Results    There were 5 deaths (10.9%) in the conventional technique group, including 4 in-hospital deaths (8.7%) and 1 late death (2.2%). Overall mortality of the conventional technique group (14.3%, 5/35) was higher than that of the sutureless technique group (0.0%, 0/11), although the difference was not statistically significant (P=0.317). Cox regression analysis showed that sex (P=0.042), age at repair (P=0.028), cardiopulmonary bypass time (P=0.007), aortic cross-clamping time (P=0.018) and duration of ventilation (P=0.042) were risk factors for postoperative mortality. The median follow-up was 18.00 (5.00, 37.75) months. Postoperative pulmonary venous obstruction occurred in 22 patients of the conventional technique group, which was significantly more than that of the sutureless technique group (P=0.000). Conclusion    For infracardiac TAPVC, sutureless technique can reduce the incidence of postoperative pulmonary venous obstruction compared with conventional technique.

Conventional and sutureless techniques for surgical repair of supracardiac total anomalous pulmonary venous connection / 中华胸心血管外科杂志

Objective@#To review our experiences with conventional and sutureless techniques in patients with supracardiac total anomalous pulmonary venous connection.@*Methods@#From January 2004 to January 2016, 150 patients with suparacardiac total anomalous pulmonary venous connection underwent conventional or sutureless techniques. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model was used to identify risk factors for death and postoperative pulmonary venous obstruction(PVO).@*Results@#There were 9 in-hospital deaths and 2 late deaths. The survival rates at 30 days, 1 year, and 12 years were 94.0%, 93.3%, and 92.7%, respectively. Follow-up was completed in 95.7% of the survivors. Median follow-up was 47 months(range: 0-136 months). Twenty-one patients required reoperation for pulmonary venous obstruction. The survival rates in neonate group is significantly lower than that in infants and children group(P=0.026). For those who were diagnosed with preoperative PVO, the survival rates(conventional group 92.3% VS sutureless group 93.9%, P=0.741) and incidence of freedom from reoperation(conventional group 55.6% VS sutureless group 90.9%, P=0.166) in both the conventional and sutureless group were similar. Multivariable analysis showed that preoperative pulmonary venous obstruction(P=0.015) and longer duration of ventilation(P=0.011) were incremental risk factors for death. Aortic cross-clamp time(P=0.038) was associated with postoperative pulmonary venous obstruction.@*Conclusion@#Both the conventional and sutureless techniques in surgical repair for supracardiac total anomalous pulmonary venous connection can achieve satisfactory outcomes.

Retrospective single center analysis:sutureless technique for neonates with total anomalous pulmonary venous connec-tion / 中华胸心血管外科杂志

Objective To retrospectively analyse the outcomes following primary Sutureless technique used in our hospi-tal for neonates with total anomalous pulmonary venous connection(TAPVC)and sum up surgical operative experiences. Meth-ods Date were collected retrospectively in 42 neonates who underwent primary Sutureless technique for TAPVC between Janu-ary 2008 and December 2015. Cardiopulmonary bypass time,aortic clamped time,velocity of pulmonary veins and other relat-ed data were recorded during and after operation. Results There were 31 males and 11 females with median age of 8. 0 days old,of whom 25 were supracardiac TAPVC(59. 5％)and 17 were infracardiac TAPVC(40. 5％). After operation, 1 neonate died and none suffered from pulmonary vein obstruction(PVO). In follow-up period,there was 1 neonates suffered from PVO. Six neonates came back to hospital again because of septicemia,poor wound healing,bronchopneumonia and incomplete intesti-nal obstruction. Conclusion Sutureless technique is a wise surgical strategy for neonates with TAPVC for better outcomes and decreasing postoperative mortality rate and recurrence rate of PVO.

Sutureless technique use in the surgery for total anomalous pulmonary venous connection in neonates / 中国胸心血管外科临床杂志

@#Objective    To analyze the sutureless technique use in the surgical repair for total anomalous pulmonary venous connection in neonates. Methods    Between September 2002 and December 2015, 71 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. There were 57 males and 14 females at median age of 8 (1, 29) d. And the median body weight was 3.3 (2.1, 4.7) kg. There were 45 patients (63.4%) with supracardiac, 26 patients (36.6%) with infracardiac. Patients were divided into two groups: a conventional technique group (29 patients) and a sutureless technique group (42 patients). To control for potential differences in the characteristics of patients between the sutureless technique group and the conventional technique group, the method of propensity-score matching was used. Results    Basic characteristics of patients after propensity-score were not different.There were 11 operative deaths (15.5%), 7 late deaths (96.%), total 18 deaths (25.4%). The mortality was 58.6% (17/29) in the conventional technique group, 2.4% (1/42) in the sutureless technique group (P=0.000). Kaplan-Meier survival curve showed a difference in   mortality between the two groups (P=0.005). The patients were followed up for 25.5 (1.0-13.0) months.Postoperative anastomotic or pulmonary vein stenosis occurred in 12 patients, 8 of them died at a higher mortality than that of the patients with smooth anastomosis [66.7% (8/12) vs. 16.9% (10/59), P=0.001]. Conclusion    The patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. Compared with conventional technique, sutureless technique can dramatically decrease the incidence of postoperative anastomotic or pulmonary vein stenosis and the mortality of surgical repair for total anomalous pulmonary venous connection in neonates.

Sutureless Treatment for Blow-out Type Left Ventricular Free Wall Rupture / 日本心臓血管外科学会雑誌

A 78-year-old woman who had had chest pain since 3 days previously, was given a diagnosis of acute myocardial infarction. Emergency coronary angiography revealed mid-left anterior descending artery and proximal right coronary artery lesions. Percutaneous coronary intervention was performed, and re-perfusion was successful. Cardiac tamponade was then diagnosed. Despite pericardial drainage, she remained in shock. After an intra-aortic balloon pump was established, an emergency operation was performed. On the operating table, her pulse disappeared. When thoracotomy was performed, a viscous hematoma was found in the pericardium. We found 3 ruptures in the left ventricular free wall, and hemorrhage. The diagnosis was a blow-out type left ventricular free wall rupture of the heart (LVFWR). We have used the patches-and-glue sutureless technique without cardiopulmonary support. This treatment for blow-type of LVFWR is rare.