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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

Long-term results estimates for patients with anomalous origin of coronary artery from the pulmonary artery, showing survival, freedom from coronary and mitral valve reintervention plots. Values shown are 10-year estimates, obtained using the Kaplan-Meier method. Vertical axis does not start at 0. Patients at risk are similar for all three survival functions.
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OPENHRT2015000277F2: Long-term results estimates for patients with anomalous origin of coronary artery from the pulmonary artery, showing survival, freedom from coronary and mitral valve reintervention plots. Values shown are 10-year estimates, obtained using the Kaplan-Meier method. Vertical axis does not start at 0. Patients at risk are similar for all three survival functions.

Mentions: Survival, freedom from coronary reintervention and freedom from mitral valve reintervention estimates at 12 years can be seen in figure 2. No patient died after 1 year of follow-up. The coronary artery reinterventions were performed in the first 2 years of follow-up (median 10.2 months), while the mitral valve reinterventions were performed in the first 5 years of follow-up (median 3.7 months). Three patients (2.9%) had pulmonary conduit and artery reinterventions: one early right ventricular outflow tract balloon dilation after 12 days, a balloon dilation of the pulmonary branches after 3 months and a pulmonary artery reconstruction after 1.8 years. Freedom from any reintervention (coronary, mitral or pulmonary) is 87.2% at 12 years, with all reinterventions (early and late) being summarised in figure 3.


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)

Long-term results estimates for patients with anomalous origin of coronary artery from the pulmonary artery, showing survival, freedom from coronary and mitral valve reintervention plots. Values shown are 10-year estimates, obtained using the Kaplan-Meier method. Vertical axis does not start at 0. Patients at risk are similar for all three survival functions.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

OPENHRT2015000277F2: Long-term results estimates for patients with anomalous origin of coronary artery from the pulmonary artery, showing survival, freedom from coronary and mitral valve reintervention plots. Values shown are 10-year estimates, obtained using the Kaplan-Meier method. Vertical axis does not start at 0. Patients at risk are similar for all three survival functions.
Mentions: Survival, freedom from coronary reintervention and freedom from mitral valve reintervention estimates at 12 years can be seen in figure 2. No patient died after 1 year of follow-up. The coronary artery reinterventions were performed in the first 2 years of follow-up (median 10.2 months), while the mitral valve reinterventions were performed in the first 5 years of follow-up (median 3.7 months). Three patients (2.9%) had pulmonary conduit and artery reinterventions: one early right ventricular outflow tract balloon dilation after 12 days, a balloon dilation of the pulmonary branches after 3 months and a pulmonary artery reconstruction after 1.8 years. Freedom from any reintervention (coronary, mitral or pulmonary) is 87.2% at 12 years, with all reinterventions (early and late) being summarised in figure 3.

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