David Kalfa1, Emre Belli2, Emile Bacha3, Virginie Lambert4, Duccio di Carlo5, Martin Kostolny6, Matej Nosal7, Jurgen Horer8, Jukka Salminen9, Jean Rubay10, Illya Yemets11, Mark Hazekamp12, Bohdan Maruszewski13, George Sarris14, Hakan Berggren15, Tjark Ebels16, Onur Baser17, François Lacour-Gayet18. 1. Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY. Electronic address: dk2757@cumc.columbia.edu. 2. Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris, France. 3. Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY. 4. Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris, France; Department of Cardiology, Institut Mutualiste Montsouris, Paris, France. 5. Department of Pediatric Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Roma, Italy. 6. Department of Pediatric Cardiac Surgery, Great Ormond Street Hospital, London, United Kingdom. 7. Department of Pediatric Cardiac Surgery, National Institute of Cardio-Vascular Diseases - Childrens Heart Center, Bratislava, Slovakia. 8. Department of Pediatric Cardiac Surgery, German Heart Center, Clinic of Cardiovascular Surgery, Munich, Germany. 9. Department of Pediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. 10. Department of Pediatric Cardiac Surgery, Saint-Luc Hospital, Brussels, Belgium. 11. Department of Pediatric Cardiac Surgery, Ukrainian Childrens Cardiac Center, Kyiv, Ukraine. 12. Department of Pediatric Cardiac Surgery, Leiden University Medical Center, Leiden, The Netherlands. 13. Department of Pediatric Cardiac Surgery, Children's Memorial Health Institute, Warsaw, Poland. 14. Department of Pediatric Cardiac Surgery, Athens Heart Surgery Institute, Mitera Pediatric and Hygeia Hospital, Athens, Greece. 15. Department of Pediatric Cardiac Surgery, Children's Heart Center, The Queen Silvia Children's Hospital, Goteborg, Sweden. 16. Department of Pediatric Cardiac Surgery, University Medical Center Groningen, Groningen, The Netherlands. 17. Center for Innovation and Outcomes Research, New York-Presbyterian, Columbia University, New York, NY. 18. Department of Pediatric Cardiac Surgery, Royal Hospital, Muscat, Oman.
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.
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.
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