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

J Thorac Cardiovasc Surg. 2018 Jul;156(1):278-286. doi: 10.1016/j.jtcvs.2018.02.038. Epub 2018 Feb 23.

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.

Keywords: congenital heart disease; outcomes; pulmonary vein stenosis; sutureless repair.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / mortality
  • Child
  • Child, Preschool
  • Endarterectomy* / adverse effects
  • Endarterectomy* / mortality
  • Europe
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • North America
  • Pulmonary Veins / diagnostic imaging
  • Pulmonary Veins / physiopathology
  • Pulmonary Veins / surgery*
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Stenosis, Pulmonary Vein / etiology
  • Stenosis, Pulmonary Vein / mortality
  • Stenosis, Pulmonary Vein / physiopathology
  • Stenosis, Pulmonary Vein / surgery*
  • Sutureless Surgical Procedures* / adverse effects
  • Sutureless Surgical Procedures* / mortality
  • Time Factors
  • Treatment Outcome
  • Vascular Patency