Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. Academic Article uri icon

Overview

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.

authors

  • Kalfa, David
  • Belli, Emre
  • Bacha, Emile
  • Lambert, Virginie
  • di Carlo, Duccio
  • Kostolny, Martin
  • Nosal, Matej
  • Horer, Jurgen
  • Salminen, Jukka
  • Rubay, Jean
  • Yemets, Illya
  • Hazekamp, Mark
  • Maruszewski, Bohdan
  • Sarris, George
  • Berggren, Hakan
  • Ebels, Tjark
  • Baser, Onur
  • Lacour-Gayet, François

publication date

  • February 23, 2018

Research

keywords

  • Cardiac Surgical Procedures
  • Endarterectomy
  • Pulmonary Veins
  • Stenosis, Pulmonary Vein
  • Sutureless Surgical Procedures

Identity

Scopus Document Identifier

  • 85044280210

Digital Object Identifier (DOI)

  • 10.1016/j.jtcvs.2018.02.038

PubMed ID

  • 29576261

Additional Document Info

volume

  • 156

issue

  • 1