Kamlesh B Tailor1, Khushboo H Dharmani1, Shankar V Kadam1, Hari Bipin R Kattana2, Suresh G Rao2
1 Department of Paediatric Cardiac Anaesthesia and Intensive Care, Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Mumbai, Maharashtra, India
2 Department of Paediatric Cardiac Surgery, Children's Heart Centre, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Mumbai, Maharashtra, India
Context: In recent years, increasing awareness and early detection has made total anomalous pulmonary venous connection (TAPVC) a relatively common congenital heart condition presenting to children's heart centers in India. The condition was associated with significant morbidity and mortality in the past due to various reasons. Improvement in perioperative management has markedly changed the outcomes of TAPVC even in a developing country.
Material and Methods: All patients with TAPVC operated between June 2013 and February 2018 at our center were included in the study. Post repair 30-days mortality and morbidity were analyzed.
Results: A total of 166 patients were divided into supracardiac (91), infracardiac (45), cardiac (18), and mixed type (12). It also divided our cohort into obstructed and unobstructed types. The duration of inotrope usage in the obstructed group was significantly higher compared to the unobstructed group. Statistically, significant difference was noticed for the duration of ventilation 85.17 ± 80.94 h in obstructed type versus 49.23 ± 60.7 h in the unobstructed group, and in ICU stay (days) in obstructed (9.64 ± 5.96) and unobstructed group (6.29 ± 5.12). The morbidity parameters such as duration of an inotrope, ventilation, and length of ICU stay had a negative correlation between body surface area (BSA) of the patient but no correlation in respect to duration of CPB and ACC time. Mortality was found to be higher in lower BSA, infracardiac type (7/9), and obstructed variants of TAPVC (9/9) patients.
Conclusions: Longer duration of inotrope usage, mechanical ventilation, and ICU stay were seen in obstructed TAPVC in comparison to unobstructed TAPVC patients. Duration of CPB or aortic cross-clamp had no effects on morbidity parameters. In our cohort of TAPVC patients, lower BSA was strongly associated with the longer requirement of inotropes, prolong ventilation time, and ICU stay. The risk factors for mortality in our study include lower BSA, infracardiac, and obstructed type of TAPVC.
Kamlesh B Tailor
505, Oakwood, Runwal Greens, Next to Fortis Hospital, MG Link Road, Nahur W, Mumbai - 400 078, Maharashtra
Source of Support: None, Conflict of Interest: None
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