Surgical management of total anomalous pulmonary venous drainage: Impact of coexisting cardiac anomalies

Background. Recent reports have cited improving results for surgical manage ment of isolated total anomalous pulmonary venous drainage. Complex cases ( with other cardiac anomalies) are less frequently reported and are associat ed with higher mortality. Methods. Retrospective review identified 170 consecutive patients treated f or total anomalous pulmonary venous drainage from 1982 to 1996: 44 cases we re "complex" (with significant associated cardiac lesions) and 126 cases we re "simple." Results. Operative mortality for simple cases decreased from 26% to 8%, and mortality for complex cases remained constant at 52%. Age, size, and the p resence of atrial isomerism were univariate predictors of mortality. Multiv ariable analysis identified only univentricular hearts and associated cardi ac lesions as predictors of operative mortality. Pulmonary artery (n = 16) and arteriopulmonary (n = 7) shunting strategies for complex cases resulted in less than 30% long-term survival. Conclusions. Despite improvement in survival for simple cases, management o f total anomalous pulmonary venous drainage with single-ventricle hearts or other associated cardiac lesions remains problematic. (C) 1998 by The Soci ety of Thoracic Surgeons.