Predictors for the use of left ventricular assist devices in infants with anomalous left coronary artery from the pulmonary artery.
BACKGROUND
Left ventricular (LV) mechanical circulatory support (MCS) may be necessary after repair of anomalous left coronary artery from the pulmonary artery. We evaluated LV function parameters for their ability to predict postoperative need for MCS.


METHODS
Fourteen infants (median age, 3.6; range, 2.3 to 12 months) underwent direct aortic reimplantation of the left coronary artery. We compared preoperative LV end-diastolic diameter, end-diastolic pressure, ejection fraction, and fraction of shortening of 8 patients with successful weaning from cardiopulmonary bypass (group 1) and 6 patients with unsuccessful weaning from cardiopulmonary bypass and temporary MCS support (group 2).


RESULTS
No perioperative or late deaths occurred. All patients at follow-up were free of reoperation (median follow-up, 10.4 years [range, 1.4 to 17 years]). Median preoperative LV end-diastolic diameter (47 [range, 41 to 60 mm] vs 32 mm [range, 21 to 36 mm]) and LV end-diastolic pressure (20 [range, 18 to 25 mm Hg] vs 12 mm Hg [range, 7 to 20 mm Hg]) were significantly higher in group 2 than in group 1 (p = 0.002 and p = 0.048). LV ejection fraction (0.28 [range, 0.19 to 0.37] vs 0.43 [range, 0.23 to 0.76]) and LV fraction of shortening (9% [range, 7% to 15%] vs 22% [range 13% to 30%]) were significantly lower in group 2 than in group 1 (p = 0.035 and p = 0.002). MCS support duration ranged from 4 to 12 days. There were no significant differences in LV function parameters at discharge or during follow-up between the groups.


CONCLUSIONS
A preoperative LV end-diastolic diameter above 40 mm is the strongest predictor for postoperative temporary MCS after anomalous left coronary artery from the pulmonary artery repair in infancy. However, even with temporary MCS, direct aortic reimplantation for anomalous left coronary artery from the pulmonary artery can be performed with no mortality and excellent LV recovery.
Nasseri
Boris A
BA
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Alexi-Meskishvili
Vladimir
V
Nordmeyer
Sarah
S
Weng
Yu-Guo
YG
Böttcher
Wolfgang
W
Hübler
Michael
M
Stamm
Christof
C
Berger
Felix
F
Hetzer
Roland
R
D000015:Abnormalities, Multiple / Q000601:surgery*; D003330:Coronary Vessel Anomalies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011379:Prognosis; D011651:Pulmonary Artery / Q000002:abnormalities*; D012189:Retrospective Studies; D016277:Ventricular Function, Left