ABSORBABLE POLYDIOXANONE SUTURE AND RESULTS IN TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION

Background. Despite theoretical advantages of absorbable suture in the growing vascular anastomosis, there has not been a documented advanta ge. over nonabsorbable suture in preventing late anastomotic stenosis in total anomalous pulmonary venous connection (TAPVC). Methods. We re viewed our experience from 1982 to 1994 with 65 hospital survivors of total TAPVC repair to examine the influence of suture type on survival and incidence of late pulmonary venous obstruction. From 1982 until 1 988, we used continuous nonabsorbable polypropylene suture for the pul monary venous-left atrial anastomosis in supracardiac, infracardiac, a nd mixed types of TAPVC. In 1989, we adopted a running absorbable poly dioxanone suture technique. Cardiac catheterization and echocardiograp hy were used to evaluate late pulmonary venous obstruction. Results. L ate pulmonary venous obstruction occurred in 17% (4/23) of survivors a fter repair with polypropylene suture compared with 3.2% (1/32) after repair with polydioxanone suture (p < 0.05). There were no instances o f late pulmonary venous obstruction in the intracardiac TAPVC group (0 /10). All late pulmonary venous obstructions occurred within 16 months after operation. The actuarial 3-year and 5-year freedom from late pu lmonary venous obstruction was 100% for intracardiac TAPVC, 96% for th e polydioxanone group, and 81% for the polypropylene group. Five patie nts died late (5/65, 7.7%), 3 in the polypropylene suture group (3/23, 13%) and 2 in the polydioxanone group (2/32, 6%). Conclusions. Contin uous absorbable polydioxanone suture for the repair of TAPVC results i n a low incidence of late pulmonary venous obstruction and death and a ppears to offer advantages over a continuous nonabsorbable suture. A c ontinuous nonabsorbable suture may limit growth of a vascular anastomo sis, particularly one involving a ''low-pressure'' anastomosis such as in the repair of TAPVC.