Midterm Surgical Outcomes for ALCAPA Repair in Infants and Children

Abstract

Background Surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) has been associated with excellent survival during recent years. The purpose of this study was to evaluate the effectiveness of reimplantation of the coronary artery and to investigate the recovery of postoperative cardiac and mitral valve (MV) function.

Methods From 2005 to 2015, 80 patients who had ALCAPA received surgical correction. Among them, 49 were infants. The median patient age was 7.8 months. Operative strategies included reimplantation of the coronary artery in 71 patients, the Takeuchi procedure in another 7 patients, and coronary artery ligation in the remaining 2 patients.

Results There were 11 hospital deaths and 2 late deaths. Six patients required intraoperative or postoperative mechanical circulatory support. A significant improvement in the ejection fraction (EF) and shortening fraction (SF) was present in all surviving patients at discharge, at a 3-month follow-up and at a 1-year follow-up. MV function improved gradually after surgical repair with no late secondary intervention.

Conclusions The repair of ALCAPA can be accomplished by establishment of a dual-coronary system, which offers an acceptable mortality rate and will rarely require a second surgery. Left ventricular (LV) recovery is a progressive process, especially for infants with impaired LV function. Concomitant MV annuloplasty is safe and reliable and can be performed as necessary in patients with moderate or severe mitral valve regurgitation.

Keywords

coronary artery disease - cardiac function - circulatory support devices - anomalous origin of left coronary artery from pulmonary artery - bland–White–Garland

Conclusion

In conclusion, this study demonstrates favorable outcomes of ALCAPA repair with an acceptable mortality rate and a very rare occurrence of secondary surgery. The LVEDD Z-score appears to be a sensitive predictor of death. LV recovery is a long-term process after surgical correction, especially for infants with impaired LV function. Concomitant MV annuloplasty is safe and reliable and can be performed as indicated in patients with moderate or severe MR.

Publikationsverlauf

Eingereicht: 20. November 2020

Angenommen: 27. Januar 2021

Artikel online veröffentlicht:
13. April 2021

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