Lack Of Correlation Between Severity Of Preoperative Mitral Regurgitation And Left Ventricular Dysfunction And Survival In Patients With Anomalous Left Coronary Artery Origin From Pulmonary Artery
Amanda Thomas1, Erin Falk1, Lazaros Kochilas1, Bahaaldin Alsoufi2.
1Emory University, Atlanta, GA, USA, 2University of Louisville, Louisville, KY, USA.
Background: Patients with anomalous left coronary artery origin from pulmonary artery (ALCAPA) develop mitral regurgitation (MR) secondary to ischemia, LV dysfunction/dilatation. ALCAPA repair eliminates ischemia and should improve MR however significant preoperative MR effect on outcomes is alarming. Methods: 173 children underwent ALCAPA repair (1982-2003): coronary implantation (n=133,77%), Takeuchi (n=26,15%), CABG (n=7,4%), coronary ligation (n=7,4%). We compared patients with moderate/severe (n= 69,40%) vs. trivial/mild MR (n=104,60%). Results: Groups comparisons are shown in TABLE. 12/173 (7%) received concomitant mitral valve repair. Hospital mortality was 19(11%) and comparable in moderate/severe 7(10%) vs. trivial/mild MR 12(12%), p=0.774. Similarly, post-repair mechanical circulatory support need was comparable: 3(4%) vs. 5(5%), p=0.464. On late follow-up, 4 patients received heart transplantations and additional 9 died (2 non-cardiac). Transplant-free survival at 20-years for patients with moderate/severe vs. trivial/mild MR was 87% and 82%, p=0.4339. While younger patients had higher operative mortality on univariate analysis, multivariable analysis did not demonstrate significant factors affecting survival. Conclusions: Significant MR is present in 40% of children with ALCAPA. Although MR pathophysiology is related to ischemia and LV dysfunction, there is no clear correlation between LV dysfunction degree and MR severity. Despite that few patients received concomitant mitral valve repair, significant preoperative MR did not affect mechanical support need, hospital death, or late transplant-free survival. Those findings might support expectant management of MR at time of ALCAPA repair.
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