Intermediate Outcomes After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery
| Autor: | Christopher W. Mastropietro, Ilias Iliopoulos, Christine M. Riley, Elizabeth Caudill, John M. Costello, Saurabh Chiwane, Michael Wilhelm, Monique Radman, Jennifer Smerling, Karl Migally, Karan B Karki, David M. Kwiatowski, Kurt D. Piggott, Margaret Gray, Katherine Cashen, Venu Amula, Keshava Murthy Narayana Gowda, Aditya Badheka, John F. Lucas, Saul Flores, Sukumar Suguna Narasimhulu, Elizabeth A.S. Moser, Adnan Bakar, Jason R. Buckley, Peter Sassalos |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Pulmonary Artery 030204 cardiovascular system & hematology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Left coronary artery Internal medicine medicine.artery Humans Medicine Survival analysis Retrospective Studies Mitral regurgitation business.industry Hazard ratio Infant Mitral Valve Insufficiency Anomalous Left Coronary Artery medicine.disease Confidence interval Transplantation Treatment Outcome 030228 respiratory system Pulmonary artery Cardiology Female Surgery Cardiology and Cardiovascular Medicine business Mitral valve regurgitation Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 112:1307-1315 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.06.130 |
| Popis: | Background 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. Methods 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. Results 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. Conclusions 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. |
| Databáze: | OpenAIRE |
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