Comparison of the Efficacy and Safety of Sutureless Technique Versus Conventional Surgery in the Initial Treatment of Total Anomalous Pulmonary Venous Connection: A Systematic Review and Meta-Analysis

Lei Shen, Nan Ding, Haiju Liu, Hanlu Yi, Jinrui Zhang, Gejingwa Zhao, Zhiqiang Li

https://doi.org/10.1002/pul2.70236 

Abstract

Total anomalous pulmonary venous connection (TAPVC) is a rare but life-threatening congenital heart defect that requires surgical correction. The sutureless technique has been developed as an alternative to conventional repair to minimize postoperative complications. This meta-analysis evaluates and compares the efficacy and safety of the two surgical approaches. A comprehensive literature search was conducted in PubMed, EMBASE, the Cochrane Library, and major Chinese databases for studies published between January 2010 and December 2024. Five retrospective comparative studies including a total of 1,327 patients met the inclusion criteria. Data were analyzed using RevMan version 5.4. Primary outcome measures included the incidence of postoperative pulmonary venous obstruction (PVO), reoperation due to PVO, total postoperative mortality, and late mortality. A random-effects model was applied to all analyses to account for anticipated clinical heterogeneity. A subgroup analysis based on TAPVC anatomical type was also performed. The meta-analysis demonstrated that the sutureless technique was associated with a significantly lower postoperative PVO rate (Odds Ratio [OR] = 0.46; 95% Confidence Interval [CI]: 0.28–0.77; p = 0.047) and a reduced reoperation rate due to PVO (OR = 0.25; 95% CI: 0.08–0.77; p = 0.049) compared with conventional surgery. Subgroup analysis indicated that the reduction in postoperative PVO was most evident among patients with infracardiac-type TAPVC. No statistically significant differences were observed in total postoperative mortality (OR = 0.66; 95% CI: 0.35–1.24; p > 0.05) or late mortality (OR = 0.37; 95% CI: 0.13–1.06; p > 0.05). Across all outcomes, heterogeneity was low to moderate (I² < 50%). Major limitations of this study include the retrospective design of all included studies, small sample sizes for certain analyses, variability in study methodology, and possible publication bias. The sutureless technique appears to be a safe and effective alternative to conventional surgery for primary TAPVC repair. It significantly reduces postoperative PVO and the need for reoperation, with the greatest benefit observed in high-risk subtypes such as infracardiac TAPVC. However, given that all available evidence is derived from retrospective studies of moderate quality, further large-scale prospective investigations are required to validate these findings and assess long-term outcomes.

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