Letter:
To the Editor,
We meticulously read your article titled “Emergency surgical treatment
of total anomalous pulmonary venous connection” by Yongtao Wu MD et
al1 and we sincerely congratulate the authors for
their appreciable efforts.
As substantiated by diverse research on the impact of emergency surgery
in patients with total anomalous pulmonary venous connection
(TAPVC),2 we agree with the conclusion of the study
that emergency surgery achieves beneficial short term results in TAPVC
patients. However, we consider it essential to mention additional
noteworthy points that would enhance the quality of this article and add
to existing knowledge of this crucial surgical procedure.
Firstly, we observed that key baseline characteristics and variables
were missing from the study. A recent retrospective study analyzing the
impact of emergency surgery without stabilization on TAPVC included
gestational age and preoperative indicators such as preoperative lowest
pH, highest plasma lactate, aspartate aminotransferase, peak creatinine,
and peak urea.2 Additionally, in another
study,3 patients were characterized on the basis of
their presentation in the emergency ward, their ventilation status and
prior administration of inotropic agents. We believe including these
characteristics would have further allowed the authors of the original
study to better stratify patients and predict the impact of emergency
surgery on them.
Secondly, the authors mentioned several common post-operative
complications of this emergency procedure, yet missed some complications
such as hospital acquired infections, low cardiac output &
diaphragmatic paralysis.2 An assessment of these
complications would have further increased the validity of the original
study.
Thirdly, a 2021 retrospective study indicated sutureless technology as
an alternate treatment option for TAPVC. Sutureless technology improved
surgical outcomes for patients with infracardiac TAPVC, preoperative
pulmonary venous obstruction, low body weight, or complicated
anatomy.4 These observations are consistent with
previous studies establishing that sutureless technology is more
suitable for high-risk patients with obstructive, infracardiac or mixed
TAPVC.4 The authors should have explored promising
effects of such technology making it a potential therapeutic application
for TAPVC.
Fourthly, the authors failed to assess central venous pressure (CVP)
which is a crucial risk factor for postoperative death in TAPVC patients
undergoing surgical treatment.4 In a previous study,
the patients were divided into three equal cohorts according to
postoperative CVP and it was found that when postoperative CVP was
greater than 8 mmHg, early and overall mortality increased
significantly.4 This is consistent with findings
observed in previous studies.4 Finally, polycentric
approaches should be adopted to enhance early diagnosis and appropriate
treatment as well as ingenious therapies explored to yield alternate
treatment options.