Timing of transfer to a tertiary care center and early surgical outcome of obstructed total anomalous pulmonary venous connection in resource-limited settings

Background: The obstructed total anomalous pulmonary venous connection (TAPVC) requires emergency surgical intervention. We conducted this study to evaluate the effect of timing to reach a tertiary care center and associated risk factors on early surgical outcomes. Materials and Methods: This is a single-center, prospective observational study of patients undergoing emergency surgical correction for an obstructed TAPVC. The parameters selected were the timing of diagnosis and transfer to the tertiary care center, transportation time, time from hospital arrival to surgery, duration of ventilation, intensive care unit (ICU) stay, in-hospital stay, inotropic support requirement, vasoactive inotropic score (VIS), and in-hospital mortality. Results: A total of 53 patients underwent TAPVC repair. Their median age was 35 days, and weight was 3 kg. The duration between onset of symptoms and arrival at hospital between deceased and survivors (29.33 ± 11 vs. 12.14 ± 4.78 h, P < 0.001, odds ratio [OR] = 1.47 P = 0.018), transportation time (12.41 ± 9.25 vs. 6.38 ± 4.12 h, P = 0.011, OR = 1.17 P = 0.04), and VIS score after 24 h of surgery ( P = 0.034, OR = 1.46) had a direct proportional morbidity and mortality. Furthermore, preoperative ventilation, sepsis, cardiopulmonary bypass time, common chamber size, postoperative acute kidney injury, low cardiac output, and rising lactate level emerged as key contributors to poor outcomes. The total in-hospital mortality rate was 15.09% (8 children). Conclusion: This study highlights the significant impact of early recognition and timely referral on patient outcomes following TAPVC repair. Prolonged symptom onset to hospital arrival, extended transportation time, and VIS score were significantly associated with increased mortality.