Sutureless technique versus conventional surgery in the primary treatment of total anomalous pulmonary venous connection: A systematic review and meta-analysis

Abstract

Backgroud: A meta-analysis was performed to compare the differences in outcomes between sutureless technique and conventional surgery for primary repair of Total Anomalous Pulmonary Venous Connection(TAPVC). Methods: Electronic databases, including PubMed, EMbase, Medline, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for primary repair of TAPVC administered by sutureless technique and conventional surgery. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results: Seven studies meeting the inclusion criteria were included, involving a total of 1293 subjects. It was observed that sutureless technique entailed a lower occurrence rate of post-operative Pulmonary Veins Obstruction (PVO) (OR, 0.52 95%CI, 0.32-0.86; P = 0.01) and re-operation due to PVO (OR, 0.28;95%CI, 0.09-0.87; P = 0.03). However, meta-analyses of hospitalization time (WMD, 5.92; 95%CI, - 7.97-19.80; P = 0.40) and post-operative mortality (OR, 0.65; 95%CI, 0.41-1.04; P = 0.07) showed no significant differences between sutureless technique and conventional surgery. Meta-analysis of Cardiopulmonary Bypass (CPB) time and aortic cross-clamp time also showed no significant differences between the two surgical approaches (WMD, 5.07; 95%CI, - 9.29-19.42; P = 0.49); (WMD, 5.73; 95%CI, - 7.76-19.23; P = 0.40), but the result remained inconclusive due to pooling result changes after sensitivity analysis. Conclusions: Compared with conventional surgery, a lower occurrence rate of post-operative PVO and re-operation due to PVO were associated with sutureless technique. Meanwhile, hospitalization time and post-operative mortality were not statistically different between the two surgical approaches. Pooling result of CPB and aortic cross-clamp time between the two groups remained inconclusive.