title: Repair of anomalous left coronary artery from the pulmonary artery in the modern era: preoperative predictors of immediate postoperative outcomes and long term cardiac follow-up.
abstract: Little is known about preoperative factors affecting postoperative morbidity following anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) repair. This study aimed at identifying predictors of postoperative outcomes, including mortality and left ventricle (LV) normalization. A retrospective, single institution review was conducted on forty-four ALCAPA repairs from April 1991 to November 2012. Preoperative clinical data and echocardiograms were analyzed. Postoperative outcomes included duration of intensive care supports and mortality. Time to normalization of LV end diastolic dimension (LVEDD) and function were assessed. Logistic regression and Cox proportional hazard analyses were used to correlate preoperative variables to postoperative outcomes. Forty-four patients underwent ALCAPA repair. No in-hospital or late mortality was observed. LVEDD, weight, and LV shortening fraction (SF) independently predicted duration of postoperative inotropic support. LVEDD and body surface area independently predicted the duration of postoperative intubation. For the infant majority, younger age predicted longer duration of postoperative intubation (p = 0.048) and LVEDD Z-score independently predicted duration of postoperative IV inotropic support (p = 0.042). LV function normalized in all patients for whom follow-up data was available. LVEDD Z-score independently predicted time to normalization of LV function (p = 0.013). ALCAPA repair in the current era has excellent outcomes, with no mortality in our cohort. Immediate postoperative morbidities are influenced by patient size, LVEDD, and preoperative SF. Outcomes of infantile ALCAPA are influenced by the degree of LV dilation. Time to normalization of LV function is related to LVEDD. Limitations included retrospective evaluation of LV function.
authors.affiliation: Division of Pediatric Cardiology, New York-Presbyterian Morgan Stanley Children's Hospital/Columbia University Medical Center, 3959 Broadway, 2 North, New York, NY, 10032-3784, USA, justin.weigand@mssm.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Weigand
authors.forename: Clement Douglass
authors.initials: CD
authors.lastname: Marshall
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D000293:Adolescent; D000375:Aging; D002648:Child; D002675:Child, Preschool; D003330:Coronary Vessel Anomalies / Q000601:surgery; D003331:Coronary Vessels / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011184:Postoperative Period; D011379:Prognosis; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016277:Ventricular Function, Left