Laura Torlai Triglia1, Alvise Guariento1, Lorenza Zanotto1, Lucia Zanotto2, Claudia Cattapan1, Renjie Hu3, Haibo Zhang3, Claudia Herbst4, Jurgen Hörer5, George Sarris6, Tjark Ebels7, Bohdan Maruszewski8, Zdzislaw Tobota8, David Blitzer9, Giulia Lorenzoni10, Daniele Bottigliengo10, Dario Gregori10, Massimo Padalino1, Giovanni Di Salvo11, Vladimiro L Vida1. 1. Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 2. Department of Statistical Sciences, University of Padua, Padua, Italy. 3. Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Shanghai Jiaotong University School of Medicine, Shanghai, China. 4. Department of Surgery, Division of Cardiac Surgery and Pediatric Heart Center, Medical University Vienna, Vienna, Austria. 5. Division for Congenital and Pediatric Heart Surgery, University Hospital of Munich (LUM), Munich, Germany. 6. Department of Pediatric and Congenital Cardiac Surgery, Athens Heart Surgery Institute, IASO Children's Hospital, Athens, Greece. 7. Departments of Congenital Cardiothoracic Surgery Thoraxcentrum, University Medical Center Groningen, Groningen, Netherlands. 8. Department for Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland. 9. Department of Surgery, Columbia University Medical Center, New York, New York, USA. 10. Biostatistic Unit, University of Padua, Padua, Italy. 11. Department of Children and Woman's Health, Pediatric Cardiology Unit, University of Padua, Padua, Italy.
Abstract
INTRODUCTION: We sought to determine the surgical outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) enrolled in the European Congenital Heart Surgeons Association (ECHSA) database. MATERIALS AND METHODS: From 1999 to 2019, 907 patients with ALCAPA underwent surgical repair and were included in the current study. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and results of concomitant mitral valve surgery and postoperative mechanical circulatory support (MCS). RESULTS: The overall in-hospital mortality was 6% (54/907) and was significantly higher in neonates (p = .01), patients with lower body surface area (BSA) (p = .01), and those requiring postoperative MCS (p = .001). Associated mitral valve surgery was performed in 144 patients (15.9%) and was associated with longer cardiopulmonary bypass (CPB) and aortic cross-clamp times (AOX) (p ≤ .0001) but was not significantly related to an increase in in-hospital mortality. Postoperative MCS was required in 66 patients (7.3%). These patients were younger (p ≤ .001), had a lower BSA (p ≤ .001), and required a longer CPB (p ≤ .001) and AOX time (p ≤ .001). CONCLUSIONS: ALCAPA repair can be achieved successfully, and with low surgical risk. Concomitant mitral valve procedures can be performed without increasing operative mortality. The use of MCS remains a valuable option, especially in younger patients.
INTRODUCTION: We sought to determine the surgical outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) enrolled in the European Congenital Heart Surgeons Association (ECHSA) database. MATERIALS AND METHODS: From 1999 to 2019, 907 patients with ALCAPA underwent surgical repair and were included in the current study. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and results of concomitant mitral valve surgery and postoperative mechanical circulatory support (MCS). RESULTS: The overall in-hospital mortality was 6% (54/907) and was significantly higher in neonates (p = .01), patients with lower body surface area (BSA) (p = .01), and those requiring postoperative MCS (p = .001). Associated mitral valve surgery was performed in 144 patients (15.9%) and was associated with longer cardiopulmonary bypass (CPB) and aortic cross-clamp times (AOX) (p ≤ .0001) but was not significantly related to an increase in in-hospital mortality. Postoperative MCS was required in 66 patients (7.3%). These patients were younger (p ≤ .001), had a lower BSA (p ≤ .001), and required a longer CPB (p ≤ .001) and AOX time (p ≤ .001). CONCLUSIONS: ALCAPA repair can be achieved successfully, and with low surgical risk. Concomitant mitral valve procedures can be performed without increasing operative mortality. The use of MCS remains a valuable option, especially in younger patients.