Surgical procedures for total anomalous pulmonary venous
connection repair using the sutureless technique and conventional
procedure
Cardiopulmonary bypass with aortic and bicaval cannulation under
moderate
hypothermia (28 ℃) was established. Before cardiac arrest, the common
chamber and
PVs were dissected from the pericardium behind the heart through a
right-side
approach. In the primary sutureless technique, the incision was
initiated at the common chamber maintaining the PV confluence and was
extended onto each PV. The incision was then carefully extended to the
pleural-pericardial reflection without entering the thoracic cavity. In
the conventional repair, the incision was made only in the common
chamber. After creating an anastomotic leak on the PV side, cold
antegrade cardioplegia was administered without circulatory arrest. An
incision was made in the posterior atrial wall, which was partially
resected to prepare for anastomosis. In sutureless technique with the
heart elevated to the right, the atrial-pericardial suture was initiated
from the left posterior to the left phrenic nerve. In conventional
procedure, the anastomotic running suture was performed from the right
side. To prevent the constriction of the anastomotic line, the running
sutures were stopped and ligated four times on the left side, lower and
upper edge, and on the right side. We did not change the operative
procedure depending on the type of TAPVC. The anastomotic range was as
follows: in sutureless technique, the anastomotic pericardial sites were
dorsal to the phrenic nerve on the left and right, inferior to the
pulmonary artery level on the cranial side, and above the inflow level
of the inferior vena cava on the caudal side. In conventional procedure,
the anastomotic site was only between common chamber and the posterior
atrial wall. After cardiopulmonary bypass withdrawal, we confirmed the
presence of sufficient anastomotic area through epicardial
echocardiography.