Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era.
(2018) The Journal of Thoracic and Cardiovascular Surgery — Vol. 156, n° 1, p. 278-286 (2018)
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- 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.
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Kalfa, D., Belli, E., Bacha, E., Lambert, V., di Carlo, D., Kostolny, M., Nosal, M., Horer, J., Salminen, J., Rubay, J., Yemets, I., Hazekamp, M., Maruszewski, B., Sarris, G., Berggren, H., Ebels, T., Baser, O., & Lacour-Gayet, F. (2018). Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. The Journal of Thoracic and Cardiovascular Surgery, 156(1), 278-286. https://doi.org/10.1016/j.jtcvs.2018.02.038 (Original work published 2018)