Factors Associated With Adverse Outcomes After Repair of Anomalous Coronary From Pulmonary Artery

Straka, Nadine; Allan, Catherine K.; Jacobs, Marshall L.; Pasquali, Sara K.; Jacobs, Jeffrey P.; Mayer, John E.; Quiñonez, Luis G.; Thiagarajan, Ravi R.; Nathan, Meena

doi:10.1016/j.athoracsur.2019.04.031

Cited by 12 publications

(13 citation statements)

References 14 publications

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“…As reported by other authors, there is no significant difference between the various surgical techniques, except for simple ligation 17 . In our large multicenter cohort study, the mortality was low (6%) (Figure 2), comparable to that of the most recent series, but still double that of the STS Congenital Database (2.8%) 18 and the United Kingdom database (2.5%) 19,20 . Although there were no significant differences in the patient population, surgical variables, or the rates of the percentage of ECMO, the discrepancy we encountered could be related to the higher mortality found in neonates (25% in our series vs. 5.3% of Straka et al) 18 .…”

Section: Discussionsupporting

confidence: 86%

“…In our large multicenter cohort study, the mortality was low (6%) (Figure 2), comparable to that of the most recent series, but still double that of the STS Congenital Database (2.8%) 18 and the United Kingdom database (2.5%) 19,20 . Although there were no significant differences in the patient population, surgical variables, or the rates of the percentage of ECMO, the discrepancy we encountered could be related to the higher mortality found in neonates (25% in our series vs. 5.3% of Straka et al) 18 . As shown by other authors, in our study neonates ( p = .01), lower body weight ( p = .003), lower BSA ( p = .01), and the need for postoperative MCS ( p < .001) were all associated with higher in‐hospital mortality 1,18 .…”

Section: Discussionsupporting

confidence: 85%

“…Although there were no significant differences in the patient population, surgical variables, or the rates of the percentage of ECMO, the discrepancy we encountered could be related to the higher mortality found in neonates (25% in our series vs. 5.3% of Straka et al) 18 . As shown by other authors, in our study neonates ( p = .01), lower body weight ( p = .003), lower BSA ( p = .01), and the need for postoperative MCS ( p < .001) were all associated with higher in‐hospital mortality 1,18 . We speculate that the need for longer CPB time (especially in neonates, who usually have less inter‐coronary collaterals and may have sustained more extensive left ventricular damage) causes a more severe clinical presentation in our patients.…”

Section: Discussioncontrasting

confidence: 73%

“…. 18 As shown by other authors, in our study neonates (p = .01), lower body weight (p = .003), lower BSA (p = .01), and the need for postoperative MCS (p < .001) were all associated with higher in-hospital mortality. 1,18…”

Section: 3% Of Straka Et Al)supporting

confidence: 81%

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Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database

et al. 2021

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Introduction We sought to determine the surgical outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) enrolled in the European Congenital Heart Surgeons Association (ECHSA) database. Materials and Methods From 1999 to 2019, 907 patients with ALCAPA underwent surgical repair and were included in the current study. The primary outcome was in‐hospital mortality. Secondary outcomes included frequency and results of concomitant mitral valve surgery and postoperative mechanical circulatory support (MCS). Results The overall in‐hospital mortality was 6% (54/907) and was significantly higher in neonates (p = .01), patients with lower body surface area (BSA) (p = .01), and those requiring postoperative MCS (p = .001). Associated mitral valve surgery was performed in 144 patients (15.9%) and was associated with longer cardiopulmonary bypass (CPB) and aortic cross‐clamp times (AOX) (p ≤ .0001) but was not significantly related to an increase in in‐hospital mortality. Postoperative MCS was required in 66 patients (7.3%). These patients were younger (p ≤ .001), had a lower BSA (p ≤ .001), and required a longer CPB (p ≤ .001) and AOX time (p ≤ .001). Conclusions ALCAPA repair can be achieved successfully, and with low surgical risk. Concomitant mitral valve procedures can be performed without increasing operative mortality. The use of MCS remains a valuable option, especially in younger patients.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 73%

Section: 3% Of Straka Et Al)supporting

confidence: 81%

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Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database

et al. 2021

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“…Straka and colleagues 20 used the PUF to analyze outcomes after surgical repair of anomalous coronary artery from the pulmonary artery (ACAPA) in 703 patients between 2007 and 2016. Study objectives were to compare patient characteristics, perioperative factors, and outcomes between survivors and nonsurvivors of surgical repair of ACAPA using a multicenter data set of ACAPA patients.…”

Section: Factors Associated With Adverse Outcomes After Repair Of Anomentioning

confidence: 99%

The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2019 Update on Research

Jacobs

Hill

et al. 2019

The Annals of Thoracic Surgery

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Analysis of Perioperative and Long-Term Outcomes Among Presentations of Anomalous Left Coronary Artery from the Pulmonary Artery Diagnosed Beyond Infancy Versus During Infancy

Straka,

Gauvreau,

Huang

et al. 2023

Pediatr Cardiol

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BackgroundAnomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) typically presents in infancy; however, there are cases of patients who survive the infant period and present later in life. We aimed to characterize patients with late ALCAPA diagnoses and to assess perioperative and functional outcomes. MethodsA retrospective chart review of patients who underwent ALCAPA repair between 1996 to 2020 at Boston Children's Hospital was performed. This cohort was divided into early ALCAPA (<1 year) and late ALCAPA (≥ 1 year) groups. Perioperative data were collected. Longitudinal functional assessments were made by echocardiography, exercise stress test, and cardiac magnetic resonance imaging. ResultsThe median age of the late ALCAPA group was 7.6 years with 25% (6/24) of patients over 18 years. The late ALCAPA group was more likely to present as an incidental nding (63%) and required less preoperative intervention compared to the early group. On preoperative echocardiogram, the late ALCAPA group had less moderate or severe mitral regurgitation (16.7% vs 62%, p<0.001) or left ventricular dysfunction (16.7% vs 89%, p <0.001) compared to the early group. Reoperation was uncommon and both groups demonstrated almost complete resolution of mitral regurgitation and left ventricular dysfunction over time. ConclusionThere are important differences between late and early ALCAPA subtypes. Revascularization results in excellent outcomes in both early and late groups but long-term surveillance of ALCAPA patients is warranted as they may have functional de cits after repair.

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Factors Associated With Adverse Outcomes After Repair of Anomalous Coronary From Pulmonary Artery

Cited by 12 publications

References 14 publications

Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database

Anomalous left coronary artery from pulmonary artery repair: Outcomes from the European Congenital Heart Surgeons Association Database

The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2019 Update on Research

Analysis of Perioperative and Long-Term Outcomes Among Presentations of Anomalous Left Coronary Artery from the Pulmonary Artery Diagnosed Beyond Infancy Versus During Infancy

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