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Surgical Outcomes for Children with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

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Abstract

Objective of this study is to summarize surgical outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in a single center. The clinical data of 89 children undergoing surgical treatment in Bei**g Children’s Hospital from January 2007 to January 2022 were retrospectively analyzed. seven patients underwent ECMO support for acute left heart failure after operation, and 2 patients were discharged after weaning successfully. Eight patients died in the early postoperative period, all of them were infants, of which 5 patients underwent ECMO support, 2 patients died of cerebral hemorrhage, 2 patients died of multiple organ dysfunction, and 4 patients died of left heart failure. Three patients died late, 3 patients were lost to follow-up, and 78 patients (96.3%) completed long-term follow-up. A logistic regression model multivariate analysis showed that postoperative moderate or severe mitral regurgitation (MR) (OR 26.948 P = 0.024) and prolonged aortic cross-clamp time (OR 1.038 P = 0.050) were independent risk factors of early mortality. Compared with the Non-MVP group (20/36), the MVP group (patients with moderate or severe MR who underwent MVP at the same time) (16/36) had more significant improvement in early postoperative LEVEF [(50.68 ± 13.85)% vs (40.50 ± 13.58)% P = 0.033] and had a lower proportion of moderate or severe MR after operation (2/16 vs 11/20 P = 0.014). Children with ALCAPA can obtain a good prognosis by reconstructing the blood supply of both coronary arteries. Mitral valvuloplasty (MVP) is more helpful in improving the prognosis of children with moderate or severe MR and mitral valve structural disease. Reasonable placement of ECMO can help reduce the mortality of critically ill children after operation, but be alert to complications in the central system.

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Data Availability

All data are incorporated into the article, the data underlying this article are available in the article.

Abbreviations

ALCAPA:

Anomalous origin of the left coronary artery from the pulmonary artery

ASD:

Atrial septal defect

CI:

Confidence interval

CICU:

Cardiac intensive care unit

ECMO:

Extracorporeal membrane oxygenation

LVEDD:

Left ventricular end-diastolic diameter

LVAD:

Left ventricular assist device

LVEF:

Left ventricular ejection fraction

LVFS:

Left ventricular fractional shortening

MR:

Mitral regurgitation

MVP:

Mitral Valvuloplasty

OR:

Odds ratio

PDA:

Patent ductus arteriosus

PFO:

Patent foramen ovale

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Acknowledgements

We acknowledge the roles of our colleagues, perfusionists, nurses, and others involved in the care of the study participants.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Bei**g Children’s Hospital, National Children’s Medical Center, Capital Medical University, Bei**g, 100045, China

    Zhangwei Wang, Nan Ding, **rui Zhang, Yaobin Zhu, Zhiqiang Li & **aofeng Li

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  1. Zhangwei Wang
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  2. Nan Ding
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  3. **rui Zhang
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  4. Yaobin Zhu
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  5. Zhiqiang Li
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  6. **aofeng Li
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Contributions

ZW: conceptualization, data curation, formal analysis, investigation, methodology, Software, validation, visualization, writing – original draft. ND: writing – review & editing. JZ: writing – review & editing. ZL: funding acquisition, project administration, resources, supervision, validation, writing – review & editing. YZ: writing – review & editing. XL: writing – review & editing.

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Correspondence to Zhiqiang Li.

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Wang, Z., Ding, N., Zhang, J. et al. Surgical Outcomes for Children with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery. Pediatr Cardiol 44, 413–423 (2023). https://doi.org/10.1007/s00246-022-02964-3

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