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

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http://hdl.handle.net/10138/303657

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European Congenital Heart Surg 2018 , ' Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era ' , Journal of Thoracic and Cardiovascular Surgery , vol. 156 , no. 1 , pp. 278-286 . https://doi.org/10.1016/j.jtcvs.2018.02.038

Title: Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era
Author: European Congenital Heart Surg
Date: 2018-07
Language: eng
Number of pages: 9
Belongs to series: Journal of Thoracic and Cardiovascular Surgery
ISSN: 0022-5223
URI: http://hdl.handle.net/10138/303657
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 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.
Subject: congenital heart disease
outcomes
pulmonary vein stenosis
sutureless repair
VENOUS CONNECTION
SURGICAL REPAIR
SINGLE-INSTITUTION
SUTURELESS REPAIR
IN-SITU
MANAGEMENT
PERICARDIUM
STRATEGIES
SEVERITY
SURVIVAL
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
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