Amanda S Thomas1, Alice Chan2, Bahaaldin Alsoufi3, Jeffrey M Vinocur4, Lazaros Kochilas5. 1. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina. 3. Department of Cardiothoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky. 4. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. 5. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia. Electronic address: lazaros.kochilas@emory.edu.
Abstract
BACKGROUND: We examined the outcomes of children (<18 years) operated on for anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS: We linked patients undergoing ALCAPA repair between 1982 and 2003 in the Pediatric Cardiac Care Consortium with the National Death Index and the Organ Procurement and Transplantation Network to examine their outcomes through 2019. RESULTS: We identified 228 children (median age, 6.0 months) operated on for ALCAPA. At the time of repair, 38.6% had severe mitral regurgitation (MR), and 71.4% had severe left ventricular (LV) dysfunction. Repair included primarily coronary reimplantation in 173 and the Takeuchi procedure in 34; concurrently, 18 underwent mitral valve (MV) operation. In-hospital death occurred in 31 (13.6%) and was not associated with MR severity (P = .846); however, among patients with moderate or severe MR, risk of death was 28% lower when undergoing MV operation (P = .033). After adjustment for other risk factors, only infant operation reached statistical significance for in-hospital death (adjusted odds ratio, 12.99; 95% CI, 1.61-104.59; P = .016). Among those discharged alive with long-term data available (n = 155), the 30-year transplant-free survival reached 95.5% (95% CI, 92.3%-98.8%) and was not associated with the degree of preoperative MR or LV dysfunction. Coronary reimplantation was associated with better long-term survival compared with other surgical techniques (adjusted odds ratio, 0.11; 95% CI, 0.02-0.74; P = .023). CONCLUSIONS: Favorable long-term outcomes can be expected after coronary artery reimplantation for ALCAPA, even in patients with severe LV dysfunction at presentation. MV operation predicted decreased risk for in-hospital mortality in patients with moderate/severe MR, but MR severity predicted neither in-hospital nor longer-term outcomes.
BACKGROUND: We examined the outcomes of children (<18 years) operated on for anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS: We linked patients undergoing ALCAPA repair between 1982 and 2003 in the Pediatric Cardiac Care Consortium with the National Death Index and the Organ Procurement and Transplantation Network to examine their outcomes through 2019. RESULTS: We identified 228 children (median age, 6.0 months) operated on for ALCAPA. At the time of repair, 38.6% had severe mitral regurgitation (MR), and 71.4% had severe left ventricular (LV) dysfunction. Repair included primarily coronary reimplantation in 173 and the Takeuchi procedure in 34; concurrently, 18 underwent mitral valve (MV) operation. In-hospital death occurred in 31 (13.6%) and was not associated with MR severity (P = .846); however, among patients with moderate or severe MR, risk of death was 28% lower when undergoing MV operation (P = .033). After adjustment for other risk factors, only infant operation reached statistical significance for in-hospital death (adjusted odds ratio, 12.99; 95% CI, 1.61-104.59; P = .016). Among those discharged alive with long-term data available (n = 155), the 30-year transplant-free survival reached 95.5% (95% CI, 92.3%-98.8%) and was not associated with the degree of preoperative MR or LV dysfunction. Coronary reimplantation was associated with better long-term survival compared with other surgical techniques (adjusted odds ratio, 0.11; 95% CI, 0.02-0.74; P = .023). CONCLUSIONS: Favorable long-term outcomes can be expected after coronary artery reimplantation for ALCAPA, even in patients with severe LV dysfunction at presentation. MV operation predicted decreased risk for in-hospital mortality in patients with moderate/severe MR, but MR severity predicted neither in-hospital nor longer-term outcomes.
Authors: Logan G Spector; Jeremiah S Menk; Jessica H Knight; Courtney McCracken; Amanda S Thomas; Jeffrey M Vinocur; Matthew E Oster; James D St Louis; James H Moller; Lazaros Kochilas Journal: J Am Coll Cardiol Date: 2018-05-29 Impact factor: 24.094
Authors: Stanimir G Georgiev; Stojan D Lazarov; Ivajlo D Mitev; Alexandra Z Latcheva; Georgi A Christov; Ivan G Velkovski; Plamen D Mitev Journal: World J Pediatr Congenit Heart Surg Date: 2012-07-01
Authors: S Takeuchi; H Imamura; K Katsumoto; I Hayashi; T Katohgi; R Yozu; M Ohkura; T Inoue Journal: J Thorac Cardiovasc Surg Date: 1979-07 Impact factor: 5.209
Authors: Tiina Ojala; Jukka Salminen; Juha-Matti Happonen; Jaana Pihkala; Eero Jokinen; Heikki Sairanen Journal: Interact Cardiovasc Thorac Surg Date: 2009-10-06
Authors: Courtney McCracken; Logan G Spector; Jeremiah S Menk; Jessica H Knight; Jeffrey M Vinocur; Amanda S Thomas; Matthew E Oster; James D St Louis; James H Moller; Lazaros Kochilas Journal: J Am Heart Assoc Date: 2018-11-20 Impact factor: 5.501