Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection

James D. St. Louis, Courtney E. McCracken, Elizabeth M. Turk, Hayley S. Hancock, Jeremiah S. Menk, Brian A. Harvey, Jeffrey M. Vinocur, Matthew E. Oster, James H. Moller, Logan G. Spector, Lazaros K. Kochilas

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Abstract

Background Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. Methods We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing. Sixty-six deaths, ten cardiac transplantations, and one bilateral lung transplantation had occurred by the end of 2014. Data collected included age and weight at time of procedure, TAPVC type, associated cardiac lesions, and postoperative length of stay. The study cohort was divided into simple and complex TAPVC based on the presence of an associated cardiac lesion. Parametric survival plots were constructed, and risk factor analyses were performed to identify demographic and clinical characteristics associated with long-term outcomes. Results Mortality or need for transplantation was 9.7% with a median follow-up of 18.4 years and a median age of death or transplant of 0.74 years. The risk of mortality and transplant after TAPVC repair was highest during the first 18 months after hospital discharge. Cardiac causes accounted for the majority of deaths. Multivariate regression models for transplant-free survival demonstrated that complex TAPVC, mixed TAPVC, and postoperative length of stay were associated with increased risk of death/transplant. Conclusions Transplant-free survival after TAPVC repair is excellent, with most deaths or transplant events occurring early. Factors associated with the worst long-term outcomes included complex TAPVC, mixed TAPVC, and prolonged postoperative length of stay.

Original languageEnglish (US)
Pages (from-to)186-192
Number of pages7
JournalAnnals of Thoracic Surgery
Volume105
Issue number1
DOIs
StatePublished - Jan 2018

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Transplants
Lung
Length of Stay
Transplantation
Pediatrics
Lung Transplantation
Mortality
Heart Transplantation
Statistical Factor Analysis
Cause of Death
Cohort Studies
Demography
Weights and Measures

Cite this

St. Louis, J. D., McCracken, C. E., Turk, E. M., Hancock, H. S., Menk, J. S., Harvey, B. A., ... Kochilas, L. K. (2018). Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection. Annals of Thoracic Surgery, 105(1), 186-192. https://doi.org/10.1016/j.athoracsur.2017.05.052

Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection. / St. Louis, James D.; McCracken, Courtney E.; Turk, Elizabeth M.; Hancock, Hayley S.; Menk, Jeremiah S.; Harvey, Brian A.; Vinocur, Jeffrey M.; Oster, Matthew E.; Moller, James H.; Spector, Logan G.; Kochilas, Lazaros K.

In: Annals of Thoracic Surgery, Vol. 105, No. 1, 01.2018, p. 186-192.

Research output: Contribution to journalArticle

St. Louis, JD, McCracken, CE, Turk, EM, Hancock, HS, Menk, JS, Harvey, BA, Vinocur, JM, Oster, ME, Moller, JH, Spector, LG & Kochilas, LK 2018, 'Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection', Annals of Thoracic Surgery, vol. 105, no. 1, pp. 186-192. https://doi.org/10.1016/j.athoracsur.2017.05.052
St. Louis, James D. ; McCracken, Courtney E. ; Turk, Elizabeth M. ; Hancock, Hayley S. ; Menk, Jeremiah S. ; Harvey, Brian A. ; Vinocur, Jeffrey M. ; Oster, Matthew E. ; Moller, James H. ; Spector, Logan G. ; Kochilas, Lazaros K. / Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 1. pp. 186-192.
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abstract = "Background Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. Methods We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing. Sixty-six deaths, ten cardiac transplantations, and one bilateral lung transplantation had occurred by the end of 2014. Data collected included age and weight at time of procedure, TAPVC type, associated cardiac lesions, and postoperative length of stay. The study cohort was divided into simple and complex TAPVC based on the presence of an associated cardiac lesion. Parametric survival plots were constructed, and risk factor analyses were performed to identify demographic and clinical characteristics associated with long-term outcomes. Results Mortality or need for transplantation was 9.7{\%} with a median follow-up of 18.4 years and a median age of death or transplant of 0.74 years. The risk of mortality and transplant after TAPVC repair was highest during the first 18 months after hospital discharge. Cardiac causes accounted for the majority of deaths. Multivariate regression models for transplant-free survival demonstrated that complex TAPVC, mixed TAPVC, and postoperative length of stay were associated with increased risk of death/transplant. Conclusions Transplant-free survival after TAPVC repair is excellent, with most deaths or transplant events occurring early. Factors associated with the worst long-term outcomes included complex TAPVC, mixed TAPVC, and prolonged postoperative length of stay.",
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T1 - Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection

AU - St. Louis, James D.

AU - McCracken, Courtney E.

AU - Turk, Elizabeth M.

AU - Hancock, Hayley S.

AU - Menk, Jeremiah S.

AU - Harvey, Brian A.

AU - Vinocur, Jeffrey M.

AU - Oster, Matthew E.

AU - Moller, James H.

AU - Spector, Logan G.

AU - Kochilas, Lazaros K.

PY - 2018/1

Y1 - 2018/1

N2 - Background Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. Methods We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing. Sixty-six deaths, ten cardiac transplantations, and one bilateral lung transplantation had occurred by the end of 2014. Data collected included age and weight at time of procedure, TAPVC type, associated cardiac lesions, and postoperative length of stay. The study cohort was divided into simple and complex TAPVC based on the presence of an associated cardiac lesion. Parametric survival plots were constructed, and risk factor analyses were performed to identify demographic and clinical characteristics associated with long-term outcomes. Results Mortality or need for transplantation was 9.7% with a median follow-up of 18.4 years and a median age of death or transplant of 0.74 years. The risk of mortality and transplant after TAPVC repair was highest during the first 18 months after hospital discharge. Cardiac causes accounted for the majority of deaths. Multivariate regression models for transplant-free survival demonstrated that complex TAPVC, mixed TAPVC, and postoperative length of stay were associated with increased risk of death/transplant. Conclusions Transplant-free survival after TAPVC repair is excellent, with most deaths or transplant events occurring early. Factors associated with the worst long-term outcomes included complex TAPVC, mixed TAPVC, and prolonged postoperative length of stay.

AB - Background Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. Methods We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing. Sixty-six deaths, ten cardiac transplantations, and one bilateral lung transplantation had occurred by the end of 2014. Data collected included age and weight at time of procedure, TAPVC type, associated cardiac lesions, and postoperative length of stay. The study cohort was divided into simple and complex TAPVC based on the presence of an associated cardiac lesion. Parametric survival plots were constructed, and risk factor analyses were performed to identify demographic and clinical characteristics associated with long-term outcomes. Results Mortality or need for transplantation was 9.7% with a median follow-up of 18.4 years and a median age of death or transplant of 0.74 years. The risk of mortality and transplant after TAPVC repair was highest during the first 18 months after hospital discharge. Cardiac causes accounted for the majority of deaths. Multivariate regression models for transplant-free survival demonstrated that complex TAPVC, mixed TAPVC, and postoperative length of stay were associated with increased risk of death/transplant. Conclusions Transplant-free survival after TAPVC repair is excellent, with most deaths or transplant events occurring early. Factors associated with the worst long-term outcomes included complex TAPVC, mixed TAPVC, and prolonged postoperative length of stay.

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