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Ann Thorac Surg 1998;66:1521-1526
© 1998 The Society of Thoracic Surgeons
a Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
Address reprint requests to Dr Caldarone, Division of Cardiovascular Surgery, The Children’s Hospital of Iowa at the University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 1616A JCP, Iowa City, IA 52242-1083
e-mail: (Chris-Caldarone{at}UIowa.edu)
Accepted for publication August 6, 1998.
Background. Recent reports have cited improving results for surgical management of isolated total anomalous pulmonary venous drainage. Complex cases (with other cardiac anomalies) are less frequently reported and are associated with higher mortality.
Methods. Retrospective review identified 170 consecutive patients treated for total anomalous pulmonary venous drainage from 1982 to 1996: 44 cases were "complex" (with significant associated cardiac lesions) and 126 cases were "simple."
Results. Operative mortality for simple cases decreased from 26% to 8%, and mortality for complex cases remained constant at 52%. Age, size, and the presence of atrial isomerism were univariate predictors of mortality. Multivariable analysis identified only univentricular hearts and associated cardiac lesions as predictors of operative mortality. Pulmonary artery (n = 16) and arteriopulmonary (n = 7) shunting strategies for complex cases resulted in less than 30% long-term survival.
Conclusions. Despite improvement in survival for simple cases, management of total anomalous pulmonary venous drainage with single-ventricle hearts or other associated cardiac lesions remains problematic.
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