Long-term Outcomes of Children Operated on for Anomalous Left Coronary Artery From the Pulmonary Artery.
Long-term Outcomes of Children Operated on for Anomalous Left Coronary Artery From the Pulmonary Artery.
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DOI：
10.1016/j.athoracsur.2021.07.053
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发表时间：
2022-04
影响因子：
4.6
通讯作者：
Kochilas, Lazaros
中科院分区：
文献类型：
--
作者：
Thomas, Amanda S.;Chan, Alice;Alsoufi, Bahaaldin;Vinocur, Jeffrey M.;Kochilas, Lazaros
我们调查了18岁的儿童因左冠状动脉畸形(ALCAPA)而接受手术的结果。我们将1982至2003年间在儿科心脏护理联盟接受ALCAPA修复的患者与国家死亡指数和器官采购和移植网络联系起来，以检查他们到2019年的结果。我们确定了228名接受ALCAPA手术的儿童(中位年龄6.0月)。在修复时，38.6%的患者有严重的二尖瓣反流(MR)，71.4%的患者有严重的左心功能不全。修补术主要包括冠状动脉再植术(n=173)和Takeuchi手术(n=34)，同期18例行二尖瓣手术(MV)。院内死亡31例(13.6%)，与MR严重程度无关(p=0.846)；然而，在中度或重度MR患者中，接受MV手术的死亡风险降低了28%(p=0.033)。在调整其他危险因素后，只有婴儿手术对住院死亡有统计学意义(AOR=12.99；95%CI：1.61,104.59，p=0.016)。在有长期资料的出院患者中(n=155)，30年无移植存活率达95.5%(95%CI：92.3~98.8)，与术前MR或左心功能不全程度无关。与其他外科技术相比，冠状动脉再植入术具有更好的长期存活率(AOR=0.11；95%CI0.02~0.74，p=0.023)。ALCAPA冠状动脉再植入术后，即使在初诊时有严重左心功能不全的患者，也可以预期良好的长期结果。MV手术可降低中/重度MR患者的住院死亡率风险，但MR严重程度既不能预测住院结果，也不能预测较长期的结果。
We examined the outcomes of children (<18 years) operated for anomalous left coronary artery from the pulmonary artery (ALCAPA). We linked patients undergoing ALCAPA repair between 1982 and 2003 in the Pediatric Cardiac Care Consortium with the National Death Index and the Organ Procurement and Transplantation Network, to examine their outcomes through 2019. We identified 228 children (median age 6.0 months) operated for ALCAPA. At time of repair, 38.6% had severe mitral regurgitation (MR) and 71.4% severe left ventricular (LV) dysfunction. Repair included primarily coronary reimplantation (n=173) and Takeuchi procedure (n=34); concurrently, 18 underwent mitral valve (MV) surgery. In-hospital death occurred in 31 (13.6%) and was not associated with MR severity (p=0.846); however, among patients with moderate or severe MR, risk of death was 28% lower when undergoing MV surgery (p=0.033). After adjustment for other risk factors, only infant surgery reached statistical significance for in-hospital death (aOR=12.99; 95% CI: 1.61, 104.59, p=0.016). Among those discharged alive with long-term data available (n=155), the 30-year transplantfree survival reached 95.5% (95% CI: 92.3–98.8) and was not associated with degree of pre-operative MR or LV dysfunction. Coronary reimplantation was associated with better long-term survival compared to other surgical techniques (aOR=0.11; 95% CI 0.02–0.74, p=0.023). Favorable long-term outcomes can be expected after coronary artery reimplantation for ALCAPA even in cases with severe LV dysfunction at presentation. MV surgery predicted decreased risk for in-hospital mortality in patients with moderate/severe MR, but MR severity predicted neither in-hospital nor longer-term outcomes.
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影响因子：
3.4
作者：
Ben Ali, Walid;Metton, Olivier;Vouhe, Pascal R.
通讯作者：
Vouhe, Pascal R.
影响因子：
4.6
作者：
Cabrera, Antonio G.;Chen, Diane W.;Fraser, Charles D., Jr.
通讯作者：
Fraser, Charles D., Jr.
影响因子：
4.6
作者：
Huddleston, CB;Balzer, DT;Mendeloff, EN
通讯作者：
Mendeloff, EN
DOI：
10.1016/s0022-5223(95)70283-0
发表时间：
1995-03-01
影响因子：
6
作者：
LAKS, H;ARDEHALI, A;ALLADA, V
通讯作者：
ALLADA, V
影响因子：
3.6
作者：
Brotherton, Helen;Philip, Roy K.
通讯作者：
Philip, Roy K.