TY - JOUR
T1 - Primary Pulmonary Vein Stenosis
T2 - Outcomes, Risk Factors, and Severity Score in a Multicentric Study
AU - European Congenital Heart Surgeons Association
AU - Kalfa, David
AU - Belli, Emre
AU - Bacha, Emile
AU - Lambert, Virginie
AU - di Carlo, Duccio
AU - Kostolny, Martin
AU - Salminen, Jukka
AU - Nosal, Matej
AU - Poncelet, Alain
AU - Horer, Jurgen
AU - Berggren, Hakan
AU - Yemets, Illya
AU - Hazekamp, Mark
AU - Maruszewski, Bohdan
AU - Sarris, George
AU - Pozzi, Marco
AU - Ebels, Tjark
AU - Lacour-Gayet, François
N1 - Publisher Copyright:
© 2017 The Society of Thoracic Surgeons
PY - 2017/7
Y1 - 2017/7
N2 - Background Primary pulmonary vein stenosis (PPVS) still carries a poor prognosis, and prognostic factors remain controversial. The aim of this study was to determine outcomes and prognostic factors after PPVS repair in the current era. Methods Thirty patients with PPVS and a normal pulmonary vein (PV) connection operated on in 10 European/North American centers (2000–2012) were included retrospectively. A specific PVS severity score was developed based on the assessment of each PV. Studied end points were death, PV reoperation, and restenosis. A univariate and multivariate risk analysis was performed. Results The mean number of affected PVs per patient was 2.7 ± 1.1. Sutureless repair was used in 21 patients (70%), endovenectomy was used in 5 patients, and patch venoplasty was used in 4 patients. Overall PV restenosis, reoperation, and mortality occurred in 50%, 40%, and 30% of patients respectively. Freedom from mortality, reoperation, and restenosis at 8 years of follow-up was 70% ± 8%, 62% ± 8%, and 47% ± 9%, respectively. Restenosis and mortality rates after sutureless repair versus nonsutureless repair were 57% (n = 12 of 21) versus 33% (n = 3 of 9) (p = 0.42) for restenosis and 38% (n = 8 of 21) versus 11% (n = 1 of 9) (p = 0.21) for mortality. Patients selected for a sutureless technique were younger and smaller and had more severe disease before operation. A postoperative high PVS score and pulmonary hypertension 1 month after the operation were independent risk factors for restenosis (hazard ratio [HR], 1.34; p = 0.002 and HR, 6.81; p = 0.02, respectively), reoperation (HR, 1.24; p = 0.01 and HR, 7.60; p = 0.02), and mortality (HR, 1.39; p = 0.01 and HR, 39.5; p = 0.008). Conclusions Primary PVS still has a guarded prognosis in the current era despite adoption of the sutureless technique. Postoperative pulmonary hypertension and severity of disease evaluated by a new severity score are independent prognostic factors regardless of surgical technique.
AB - Background Primary pulmonary vein stenosis (PPVS) still carries a poor prognosis, and prognostic factors remain controversial. The aim of this study was to determine outcomes and prognostic factors after PPVS repair in the current era. Methods Thirty patients with PPVS and a normal pulmonary vein (PV) connection operated on in 10 European/North American centers (2000–2012) were included retrospectively. A specific PVS severity score was developed based on the assessment of each PV. Studied end points were death, PV reoperation, and restenosis. A univariate and multivariate risk analysis was performed. Results The mean number of affected PVs per patient was 2.7 ± 1.1. Sutureless repair was used in 21 patients (70%), endovenectomy was used in 5 patients, and patch venoplasty was used in 4 patients. Overall PV restenosis, reoperation, and mortality occurred in 50%, 40%, and 30% of patients respectively. Freedom from mortality, reoperation, and restenosis at 8 years of follow-up was 70% ± 8%, 62% ± 8%, and 47% ± 9%, respectively. Restenosis and mortality rates after sutureless repair versus nonsutureless repair were 57% (n = 12 of 21) versus 33% (n = 3 of 9) (p = 0.42) for restenosis and 38% (n = 8 of 21) versus 11% (n = 1 of 9) (p = 0.21) for mortality. Patients selected for a sutureless technique were younger and smaller and had more severe disease before operation. A postoperative high PVS score and pulmonary hypertension 1 month after the operation were independent risk factors for restenosis (hazard ratio [HR], 1.34; p = 0.002 and HR, 6.81; p = 0.02, respectively), reoperation (HR, 1.24; p = 0.01 and HR, 7.60; p = 0.02), and mortality (HR, 1.39; p = 0.01 and HR, 39.5; p = 0.008). Conclusions Primary PVS still has a guarded prognosis in the current era despite adoption of the sutureless technique. Postoperative pulmonary hypertension and severity of disease evaluated by a new severity score are independent prognostic factors regardless of surgical technique.
UR - https://www.scopus.com/pages/publications/85020929361
U2 - 10.1016/j.athoracsur.2017.03.022
DO - 10.1016/j.athoracsur.2017.03.022
M3 - Article
C2 - 28633223
AN - SCOPUS:85020929361
SN - 0003-4975
VL - 104
SP - 182
EP - 189
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -