Analysis of Risk Factors Associated with Early Mortality in Total Anomalous Pulmonary Venous Connection (TAPVC) Repairs Performed Over a Period of 10 Years – A Retrospective Observational Study
Authors: Murtaza Sheikh Mohd , Prakash Mohit , Gupta Shradha , Devagourou V. 
Published: January 2025

Objectives:
Total anomalous pulmonary venous connection (TAPVC) is a congenital cardiac malformation. If it is not repaired surgically, the chances of survival of the patient are meager. Due to the improved perioperative care and surgical techniques, the overall results have also improved. Our study assesses the risk factors in relation to early mortality in TAPVC repairs performed over a period of 10 years by a single surgeon in our institute.

Material and Methods:
Eighty-eight patients who were surgically treated for TAPVC at our institute over a period of 10 years from June 01, 2009, to May 31, 2019, by a single surgeon formed the basis of this retrospective observational study. The study protocol was reviewed and approved by the Institutional Ethics Committee. The information regarding patient demographic details, pre-operative evaluation, surgical procedure, post-operative course, and follow-up after discharge was retrieved by searching operation theatre (O.T) registries, medical record sections, and finally by patient follow-up in outpatient department/telephonic follow-up.

Results:
Mean age and weight at surgery were 10.82 months and 5.27 kg, respectively. Out of 88, 64 (72.7%) were male patients and 24 (27.3%) were female patients. About 25% of the participants had age ≤1 month. The TAPVC type was supracardiac in 46.6% cases, cardiac in 24 (27.3%), infracardiac in 14 (15.9%), and mixed in 9 (10.2%). Of the 88 TAPVC patients, 33 (37.5%) were obstructed at the time of operation. Twenty-nine (33%) patients had to be taken up for emergency TAPVC repair. Out of the 88 patients, 33 had pre-operative pulmonary artery hypertension (PAH). Thirteen (14.8%) patients were on mechanical ventilation preoperatively and 18 (20.5%) patients required pre-operative inotropic support. Mean cardiopulmonary bypass (CPB) time in our study was 63.36 min, and cross-clamp duration was 34.4 min. Patients required to be ventilated postoperatively for an average of 4.18 days (±2.17 standard deviation [SD]). Mean intensive care unit (ICU) and hospital stay were 8.01 days (±3.63 SD) and 17.8 days (±10.47 SD), respectively. Eleven (12.5%) patients died postoperatively. Out of these, eight had age of <1 month (P < 0.001). Furthermore, the mean weight of the patients with early mortality is 3.85 kg (±2.17 SD), while the mean weight of the surviving patients is 5.48 kg (±3.35 SD), (P < 0.05). All of the 11 mortalities had at least some PAH in the post-operative period. However, 16 out of the surviving 77 patients had PAH (P < 0.001).

Conclusion:
Supracardiac type was the most common subtype of TAPVC in our study (46.6%) followed by cardiac (27.3%). Early mortality was 12.5%, while late mortality was 3.9%. Age <1 month, low weight at the time of surgery, pre-operative obstructed pulmonary veins, pre-operative need of mechanical ventilation, pre-operative inotrope requirement, repair of TAPVC on an emergency basis, and post-operative PAH were important risk factors for early mortality. Gender, TAPVC type, pre-operative ventricular function, pre-operative PAH, associated cardiac lesions, CPB time, aortic cross clamp time, duration of ICU stay, duration of hospital stay, and post-operative ventricular function have not been found to have any statistically significant association with early mortality in our study.