Abstract
BACKGROUND: Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect requiring surgical correction and is associated with significant postoperative risks, such as prolonged ventilatory support and mortality. This study aimed to identify perioperative factors that contribute to protracted ventilatory support in infants undergoing TAPVC repair. METHODS: Infants aged under 6 months with TAPVC who underwent primary surgical repair between January 2017 and December 2022 were retrospectively analyzed. Patients were divided into two groups based on the duration of postoperative ventilatory support: group A (prolonged recovery, with ventilatory support durations exceeding the 75th percentile) and group B (normal recovery). Perioperative characteristics between the groups were compared using various statistical methods, including multivariate logistic regression. RESULTS: A total of 323 children were analyzed, with 66 and 257 children in groups A and B, respectively. The median duration of ventilatory support and intensive care unit (ICU) stay was significantly longer in group A (182 hours and 12 days) compared to group B (52 hours and 5.5 days). Multivariate logistic regression analysis identified the following as independent risk factors for prolonged recovery period: weight-for-age Z score <-2 (p = 0.022), preoperative pulmonary venous obstruction (p = 0.042), emergency surgery (p = 0.043), prolonged cardiopulmonary bypass duration and aortic cross-clamp (ACC) time (p = 0.014), diaphragmatic injury for plication (p = 0.045), and velocity of pulmonary venous flow/left ventricular end diastolic dimension (PV/LVDD) ratio (p = 0.012). These factors individually increase the likelihood of delayed recovery by 6.4-fold, 6-fold, 5.9-fold, 8.6-fold, 5.3-fold, and 9.8-fold, respectively. CONCLUSION: While most infants recover suitably after TAPVC repair, those with a weight-for-age Z score <-2, preoperative pulmonary venous obstruction, emergency surgery, prolonged cardiopulmonary bypass and aortic cross-clamp time, diaphragmatic injury, and a PV/LVDD ratio >0.624 are at a higher risk for prolonged recovery. Early identification of these factors can help optimize perioperative management and improve outcomes.