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Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database.

Fudulu DP, Dorobantu DM, Azar Sharabiani MT, Angelini GD, Caputo M, Parry AJ, Stoica SC - Open Heart (2015)

Bottom Line: To our knowledge this is the largest series to date.These preliminary national results show that early outcomes are good and medium-term attrition acceptable.Poor outcomes are correlated with early presentation, also with the need for postoperative circulatory support.

View Article: PubMed Central - PubMed

Affiliation: University Hospitals Bristol NHS Trust , Bristol , UK.

ABSTRACT

Background: Anomalous coronary artery from the pulmonary artery (ACAPA) is a very rare congenital anomaly that often occurs during infancy. Patients can present in a critical condition.

Methods: We analysed procedure-related data from a national audit database for the period 2000-2013.

Results: A total of 120 patients <1 year had repair of isolated ACAPA using a coronary transfer or the tunnel (Takeuchi) operation. Seven patients (6.8%) required a mitral valve procedure at index and eight patients (7.8%) had a mitral valve repair/replacement during follow-up, including mitral reoperations. Follow-up data (>30 days) were available in 102 patients and the mean follow-up time was 4.7 years. The 30-day overall mortality was 1.9%, higher for neonates (16.7% vs 1%, p=0.1) and after postoperative extracorporeal membrane oxygenation (ECMO) (20% vs 1%, p=0.09). At 10 years the survival estimate is 95.1%, freedom from coronary and mitral reintervention being 95.9% and 91.2%, respectively. Use of postoperative ECMO was a risk factor for long-term mortality (p<0.001). Risk factors for coronary reintervention were age under 30 days (p=0.06) and the need for postoperative ECMO (p=0.02). Age under 30 days (p=0.002) was a risk factor for mitral reintervention.

Conclusions: To our knowledge this is the largest series to date. These preliminary national results show that early outcomes are good and medium-term attrition acceptable. Poor outcomes are correlated with early presentation, also with the need for postoperative circulatory support.

No MeSH data available.


Related in: MedlinePlus

Patient inclusion and exclusion flow chart. ACAPA, anomalous origin of coronary artery from the pulmonary artery; CABG, coronary artery bypass grafting.
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OPENHRT2015000277F1: Patient inclusion and exclusion flow chart. ACAPA, anomalous origin of coronary artery from the pulmonary artery; CABG, coronary artery bypass grafting.

Mentions: All data available on the patients undergoing a coronary artery procedure for a congenital cause between 2000 and 2013 were selected and anonymised. A total of 249 patients of all ages with either an ‘ACAPA diagnosis’ or an ‘ACAPA repair procedure’ were identified in the NICOR data set, which does not differentiate between the types of ACAPA repair procedures (ie, tunnelling or reimplantation). Out of these, 214 had an ACAPA repair, 128 of them being infants; 75 patients older than 1 year were excluded, as were 11 patients with an undocumented age, due to administrative errors. Since the objective of the study was to report the results in patients having ACAPA as their primary defect, we excluded four infants with complex abnormalities (one with partially anomalous pulmonary venous connections, one with atrioventricular septal defect and two with double-outlet right ventricle) and one patient with severe aortic valve disease requiring a Ross operation at index. We also excluded the three infants who were listed as having a coronary artery bypass grafting (CABG) procedure. Patient inclusion/exclusion details can be found in figure 1.


Outcomes following repair of anomalous coronary artery from the pulmonary artery in infants: results from a procedure-based national database.

Fudulu DP, Dorobantu DM, Azar Sharabiani MT, Angelini GD, Caputo M, Parry AJ, Stoica SC - Open Heart (2015)

Patient inclusion and exclusion flow chart. ACAPA, anomalous origin of coronary artery from the pulmonary artery; CABG, coronary artery bypass grafting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4561674&req=5

OPENHRT2015000277F1: Patient inclusion and exclusion flow chart. ACAPA, anomalous origin of coronary artery from the pulmonary artery; CABG, coronary artery bypass grafting.
Mentions: All data available on the patients undergoing a coronary artery procedure for a congenital cause between 2000 and 2013 were selected and anonymised. A total of 249 patients of all ages with either an ‘ACAPA diagnosis’ or an ‘ACAPA repair procedure’ were identified in the NICOR data set, which does not differentiate between the types of ACAPA repair procedures (ie, tunnelling or reimplantation). Out of these, 214 had an ACAPA repair, 128 of them being infants; 75 patients older than 1 year were excluded, as were 11 patients with an undocumented age, due to administrative errors. Since the objective of the study was to report the results in patients having ACAPA as their primary defect, we excluded four infants with complex abnormalities (one with partially anomalous pulmonary venous connections, one with atrioventricular septal defect and two with double-outlet right ventricle) and one patient with severe aortic valve disease requiring a Ross operation at index. We also excluded the three infants who were listed as having a coronary artery bypass grafting (CABG) procedure. Patient inclusion/exclusion details can be found in figure 1.

Bottom Line: To our knowledge this is the largest series to date.These preliminary national results show that early outcomes are good and medium-term attrition acceptable.Poor outcomes are correlated with early presentation, also with the need for postoperative circulatory support.

View Article: PubMed Central - PubMed

Affiliation: University Hospitals Bristol NHS Trust , Bristol , UK.

ABSTRACT

Background: Anomalous coronary artery from the pulmonary artery (ACAPA) is a very rare congenital anomaly that often occurs during infancy. Patients can present in a critical condition.

Methods: We analysed procedure-related data from a national audit database for the period 2000-2013.

Results: A total of 120 patients <1 year had repair of isolated ACAPA using a coronary transfer or the tunnel (Takeuchi) operation. Seven patients (6.8%) required a mitral valve procedure at index and eight patients (7.8%) had a mitral valve repair/replacement during follow-up, including mitral reoperations. Follow-up data (>30 days) were available in 102 patients and the mean follow-up time was 4.7 years. The 30-day overall mortality was 1.9%, higher for neonates (16.7% vs 1%, p=0.1) and after postoperative extracorporeal membrane oxygenation (ECMO) (20% vs 1%, p=0.09). At 10 years the survival estimate is 95.1%, freedom from coronary and mitral reintervention being 95.9% and 91.2%, respectively. Use of postoperative ECMO was a risk factor for long-term mortality (p<0.001). Risk factors for coronary reintervention were age under 30 days (p=0.06) and the need for postoperative ECMO (p=0.02). Age under 30 days (p=0.002) was a risk factor for mitral reintervention.

Conclusions: To our knowledge this is the largest series to date. These preliminary national results show that early outcomes are good and medium-term attrition acceptable. Poor outcomes are correlated with early presentation, also with the need for postoperative circulatory support.

No MeSH data available.


Related in: MedlinePlus