Efficacy of sutureless technique versus conventional surgery for total anomalous pulmonary venous connection: a systematic review and Meta-analysis

Objective To perform meta-analysis for comparing the outcomes of sutureless technique versus conventional surgery for total anomalous pulmonary venous connection (TAPVC). Methods Electronic databases, including PubMed, EMbase, Medline, CNKI, Wanfang and Weipu, were searched systematically for the literatures aimed mainly at comparing the therapeutic effects for TAPVC administrated by sutureless technique and conventional surgery. The corresponding datasets were extracted and two reviewers independently assessed the methodological quality. Meta-analysis was conducted with Revman 5.3 and Stata 12.0 adopted for detecting the publication bias. Results Seven studies fulfilling the inclusion criteria were included, involving a total of 1293 subjects. Sutureless technique entailed a lower occurrence rate of postoperative pulmonary vein 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 postoperative 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 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). However, the results remained inconclusive due to pooling result changes after sensitivity analysis. No publication bias was detected according to the results of Begg’s and Egger’s test. Conclusions Compared with conventional surgery, a lower occurrence rate of postoperative PVO and re-operation due to PVO are obtained with sutureless technique. Meanwhile, hospitalization time and postoperative mortality are not statistically different between two surgical approaches. Pooling result of CPB and aortic cross-clamp time between two groups remains inconclusive. However, this study is based on retrospective studies so that the level of evidence remains low. More larger sample size randomized controlled trials should be designed to explore the safety and effectiveness of sutureless technique during primary repair of TAPVC. Key words: Heart disease; Anomalous pulmonary venous connection; Sutureless technique; Meta-analysis