Journal article
Intermediate Outcomes After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery
The Annals of thoracic surgery, Vol.112(4), pp.1307-1315
09/20/2020
DOI: 10.1016/j.athoracsur.2020.06.130
PMID: 32961142
Abstract
Multicenter studies on infants with anomalous left coronary artery from the pulmonary artery (ALCAPA) are lacking. We report the intermediate-term outcomes after ALCAPA repair in a multicenter cohort and identify risk factors for reintervention or death after discharge.
We retrospectively reviewed infants under 1 year of age who underwent ALCAPA repair from January 2009 to March 2018 at 21 US centers. The primary composite outcome was freedom from reintervention or death after discharge. We used the Kaplan-Meier survival analysis to examine freedom from reintervention or death and the Cox proportional hazard analysis to identify risk factors for this composite outcome.
One hundred seventy-seven infants underwent ALCAPA repair; 170 (97%) survived to hospital discharge without transplantation. Twenty-three patients were lost to follow-up. The median duration of follow-up in the remaining 147 patients was 3.8 years (25%, 75%: 1.9 years, 6.0 years). Echocardiographic data were available at ∼3 years after discharge in 98 patients. Left ventricular function was normal in 96 patients (98%), whereas 26 patients (27%) had greater than mild mitral valve regurgitation. Sixteen patients (11%) underwent 20 reinterventions with 1 late death. Patients undergoing the Takeuchi procedure or atypical repairs (hazard ratio, 8.0; 95% confidence interval, 2.1-30.0) or with moderate or greater mitral regurgitation on discharge echocardiogram (hazard ratio, 3.4; 95% confidence interval, 1.2-9.1) were at increased risk for reintervention.
Intermediate-term outcomes after ALCAPA repair in infants are favorable. Persistent left ventricular dysfunction and reinterventions were uncommon, and mortality was rare. Patients who required atypical surgical repair or had moderate or greater mitral regurgitation at discharge warrant closer follow-up.
Details
- Title: Subtitle
- Intermediate Outcomes After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery
- Creators
- Monique Radman - Seattle Children's HospitalChristopher W Mastropietro - Riley Hospital for ChildrenJohn M Costello - Medical University of South CarolinaVenu Amula - Primary Children's HospitalSaul Flores - Texas Children's HospitalElizabeth Caudill - Levine Children's HospitalKaran Karki - Le Bonheur Children's HospitalKarl Migally - Lurie Children's HospitalSukumar Narasimhulu - Arnold Palmer Hospital for ChildrenKurt Piggott - Children's Hospital of New OrleansPeter Sassalos - C. S. Mott Children's HospitalMichael Wilhelm - University of Wisconsin–MadisonElizabeth A S Moser - Riley Hospital for ChildrenKatherine Cashen - Children's Hospital of MichiganCollaborative Research from the Pediatric Cardiac Intensive Care Society (CoRe-PCICS) Investigators
- Contributors
- Aditya Badheka (Contributor) - University of Iowa, Critical Care
- Resource Type
- Journal article
- Publication Details
- The Annals of thoracic surgery, Vol.112(4), pp.1307-1315
- DOI
- 10.1016/j.athoracsur.2020.06.130
- PMID
- 32961142
- ISSN
- 0003-4975
- eISSN
- 1552-6259
- Language
- English
- Date published
- 09/20/2020
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984354154402771
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