Sutureless technique and conventional procedure for total anomalous pulmonary venous connection
Although the “sutureless technique” is a common surgical procedure for postoperative PVO after TAPVC repair (6), the indication of this technique versus the conventional procedure for the primary repair of TAPVC is controversial (7-9). Yamashita and colleagues reported that the sutureless technique for postoperative PVO does not improve prognosis; however, it is effective in PVO release (10). The sutureless technique theoretically avoids intimal proliferation in repaired native PVs and prevents the kinking or distortion of the anastomotic site. Several institutions primarily apply this technique (11,12). However, no significant difference in mortality between the primary sutureless technique and conventional repair for simple TAPVC and single ventricle with TAPVC has been observed (10,13). In our experience, while there were no significant difference between the sutureless and conventional groups (P=0.43), there was only one branch PVO in sutureless technique and one or more branch PVOs in conventional procedure which might have caused death from heart failure after Fontan. Our early results may not suggest the more usefulness of the primary sutureless technique than conventional procedure for RAI with TAPVC, including preoperative PVO (7 of 12 patients). Although both procedures were useful for TAPVC repair, PVO can still occur and strategies to prevent it are necessary.