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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

Flow chart showing reinterventions by type in patients with anomalous origin of coronary artery from the pulmonary artery patients, divided into early (before 30 days) and late (after 30 days). Some patients underwent both early and late reinterventions or more than one late reintervention.
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OPENHRT2015000277F3: Flow chart showing reinterventions by type in patients with anomalous origin of coronary artery from the pulmonary artery patients, divided into early (before 30 days) and late (after 30 days). Some patients underwent both early and late reinterventions or more than one late reintervention.

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)

Flow chart showing reinterventions by type in patients with anomalous origin of coronary artery from the pulmonary artery patients, divided into early (before 30 days) and late (after 30 days). Some patients underwent both early and late reinterventions or more than one late reintervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

OPENHRT2015000277F3: Flow chart showing reinterventions by type in patients with anomalous origin of coronary artery from the pulmonary artery patients, divided into early (before 30 days) and late (after 30 days). Some patients underwent both early and late reinterventions or more than one late reintervention.
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