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.