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

European Congenital Heart Surgeons Association

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)278-286
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume156
Issue number1
DOIs
Publication statusPublished - Jul 2018

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Pulmonary Veins
Mortality
Scimitar Syndrome
Endarterectomy
Pulmonary Vein Stenosis
Multivariate Analysis
Sutureless Surgical Procedures
Protective Factors

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Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. / European Congenital Heart Surgeons Association.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 156, No. 1, 07.2018, p. 278-286.

Research output: Contribution to journalArticle

European Congenital Heart Surgeons Association. / Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era. In: Journal of Thoracic and Cardiovascular Surgery. 2018 ; Vol. 156, No. 1. pp. 278-286.
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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.",
author = "{European Congenital Heart Surgeons Association} and David Kalfa and Emre Belli and Emile Bacha and Virginie Lambert and {di Carlo}, Duccio and Martin Kostolny and Matej Nosal and Jurgen Horer and Jukka Salminen and Jean Rubay and Illya Yemets and Mark Hazekamp and Bohdan Maruszewski and George Sarris and Hakan Berggren and Tjark Ebels and Onur Baser and Fran{\cc}ois Lacour-Gayet",
note = "Copyright {\circledC} 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.",
year = "2018",
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T1 - Outcomes and prognostic factors for postsurgical pulmonary vein stenosis in the current era

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 - Nosal, Matej

AU - Horer, Jurgen

AU - Salminen, Jukka

AU - Rubay, Jean

AU - Yemets, Illya

AU - Hazekamp, Mark

AU - Maruszewski, Bohdan

AU - Sarris, George

AU - Berggren, Hakan

AU - Ebels, Tjark

AU - Baser, Onur

AU - Lacour-Gayet, François

N1 - Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - 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.

AB - 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.

U2 - 10.1016/j.jtcvs.2018.02.038

DO - 10.1016/j.jtcvs.2018.02.038

M3 - Article

VL - 156

SP - 278

EP - 286

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -