Analysis of the risk factors for extracorporeal membrane oxygenation use after surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary artery combined with severe left ventricular dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Min ¹ , LI Xia ¹ , LU Zhongyuan ¹ , LI Shoujun ² ,  WANG Xu ¹

1. Department of Pediatric ICU, Pediatric Cardiac Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Surgery, Pediatric Cardiac Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

WANG Xu, Email: fwpicu@163.com

Keywords：

Congenital heart disease; anomalous origin of the left coronary artery from the pulmonary artery; extracorporeal membrane oxygenation; aortic cross-clamping; left ventricular dysfunction

DOI：

10.7507/1007-4848.202102009

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Objective To analyze the early outcomes of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) patients with severe left ventricular dysfunction after surgical repair, and to explore the predictors for extracorporeal membrane oxygenation (ECMO) support for these patients.Methods The clinical data of ALCAPA patients with severe left ventricular dysfunction (left ventricular ejection fraction<40%) who underwent coronary artery reimplantation in the pediatric center of our hospital from 2013 to 2020 were retrospectively analyzed. The patients were divided into an ECMO group and a non-ECMO group. Clinical data of the two groups were compared and analyzed.Results A total of 64 ALCAPA patients were included. There were 7 patients in the ECMO group, including 4 males and 3 females aged 6.58±1.84 months. There were 57 pateints in the non-ECMO group, including 30 males and 27 females aged 4.34±2.56 months. The mortality of the patients was 6.25% (4/64), including 2 patients in the ECMO group, and 2 in the non-ECMO group. The postoperative complications rate was significantly higher in the ECMO group than that in the non-ECMO group (P=0.041). There were statistical differences in the cardiopulmonary bypass time [254 (153, 417) min vs. 106 (51, 192) min, P=0.013], aortic cross-clamping (ACC) time (89.57±13.66 min vs. 61.58±19.57 min, P=0.039), and preoperative left ventricular end-diastolic diameter/body surface area (132.32±14.71 mm/m² vs. 108.00±29.64 mm/m², P=0.040) between the two groups. Multivariate logistic regression analysis showed that ACC time was an independent risk factor for postoperative ECMO support (P=0.005). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.757, the sensitivity was 85.70%, specificity was 66.70%, with the cut-off value of 66 min.Conclusion ACC time is an independent risk factor for postoperative ECMO support. Patients with an ACC time>66 min have a significantly higher risk for ECMO support after the surgery.

Citation： ZENG Min, LI Xia, LU Zhongyuan, LI Shoujun, WANG Xu. Analysis of the risk factors for extracorporeal membrane oxygenation use after surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary artery combined with severe left ventricular dysfunction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 551-556. doi: 10.7507/1007-4848.202102009 Copy

1.	Jinmei Z, Yunfei L, Yue W, et al. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) diagnosed in children and adolescents. J Cardiothorac Surg, 2020, 15(1): 90.
2.	芮璐, 李守軍, 張昌偉, 等. 左冠狀動脈異常起源于肺動脈患兒86例外科治療近期結果分析. 臨床外科雜志, 2019, 27(5): 416-418.
3.	齊玉娟, 李培軍. 左冠狀動脈起源于肺動脈的外科治療進展. 中國胸心血管外科臨床雜志, 2017, 24(3): 239-242.
4.	Zhang W, Hu R, Zhu Y, et al. Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation. J Thorac Cardiovasc Surg, 2020, 159(5): 1945-1952.
5.	Zheng J, Ding W, Xiao Y, et al. Anomalous origin of the left coronary artery from the pulmonary artery in children: 15 years experience. Pediatr Cardiol, 2011, 32(1): 24-31.
6.	鄭景浩, 張蔚, 何曉敏, 等. 嬰幼兒重癥ALCAPA手術治療的臨床初探. 中華胸心血管外科雜志, 2019, 35(3): 140-144.
7.	Edwin F, Kinsley RH, Quarshie A, et al. Prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. J Thorac Cardiovasc Surg, 2012, 144(1): 160-165.
8.	Sasikumar D, Dharan BS, Arunakumar P, et al. The outcome of mitral regurgitation after the repair of anomalous left coronary artery from the pulmonary artery in infants and older children. Interact Cardiovasc Thorac Surg, 2018, 27(2): 238-242.
9.	Ismail M, Jijeh A, Alhuwaymil RM, et al. Long-term outcome of the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in children after cardiac surgery: A single-center experience. Cureus, 2020, 12(12): e11829.
10.	Mishra A. Surgical management of anomalous origin of coronary artery from pulmonary artery. Indian J Thorac Cardiovasc Surg, 2021, 37(Suppl 1): 1-13.
11.	Di Salvo G, Siblini G, Issa Z, et al. Left ventricular mechanics in patients with abnormal origin of the left main coronary artery from the pulmonary trunk late after successful repair. Cardiology, 2017, 136(2): 71-76.
12.	Zhang C, Zhang H, Yan J, et al. Mid-term outcome for anomalous origin of the left coronary artery from the pulmonary artery. Heart Lung Circ, 2020, 29(5): 766-771.
13.	Ma K, Wang L, Hua Z, et al. Outcomes of coronary transfer for anomalous origin of the left coronary artery from the pulmonary artery. Eur J Cardiothorac Surg, 2015, 47(4): 659-664.
14.	Nasseri BA, Alexi-Meskishvili V, Nordmeyer S, et al. Predictors for the use of left ventricular assist devices in infants with anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg, 2010, 90(2): 580-587.
15.	Wang J, Wang C, Wang Y, et al. Fluid overload in special pediatric cohorts with anomalous origin of the left coronary artery from the pulmonary artery following surgical repair. J Cardiothorac Vasc Anesth, 2020, 34(6): 1565-1572.
16.	Gist KM, Henry BM, Borasino S, et al. Prophylactic peritoneal dialysis after the arterial switch operation: A retrospective cohort study. Ann Thorac Surg, 2021, 111(2): 655-661.
17.	Wu Y, Zhao T, Li Y, et al. Use of extracorporeal membrane oxygenation after congenital heart disease repair: A systematic review and meta-analysis. Front Cardiovasc Med, 2020, 7: 583289.

1. Jinmei Z, Yunfei L, Yue W, et al. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) diagnosed in children and adolescents. J Cardiothorac Surg, 2020, 15(1): 90.
2. 芮璐, 李守軍, 張昌偉, 等. 左冠狀動脈異常起源于肺動脈患兒86例外科治療近期結果分析. 臨床外科雜志, 2019, 27(5): 416-418.
3. 齊玉娟, 李培軍. 左冠狀動脈起源于肺動脈的外科治療進展. 中國胸心血管外科臨床雜志, 2017, 24(3): 239-242.
4. Zhang W, Hu R, Zhu Y, et al. Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation. J Thorac Cardiovasc Surg, 2020, 159(5): 1945-1952.
5. Zheng J, Ding W, Xiao Y, et al. Anomalous origin of the left coronary artery from the pulmonary artery in children: 15 years experience. Pediatr Cardiol, 2011, 32(1): 24-31.
6. 鄭景浩, 張蔚, 何曉敏, 等. 嬰幼兒重癥ALCAPA手術治療的臨床初探. 中華胸心血管外科雜志, 2019, 35(3): 140-144.
7. Edwin F, Kinsley RH, Quarshie A, et al. Prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. J Thorac Cardiovasc Surg, 2012, 144(1): 160-165.
8. Sasikumar D, Dharan BS, Arunakumar P, et al. The outcome of mitral regurgitation after the repair of anomalous left coronary artery from the pulmonary artery in infants and older children. Interact Cardiovasc Thorac Surg, 2018, 27(2): 238-242.
9. Ismail M, Jijeh A, Alhuwaymil RM, et al. Long-term outcome of the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in children after cardiac surgery: A single-center experience. Cureus, 2020, 12(12): e11829.
10. Mishra A. Surgical management of anomalous origin of coronary artery from pulmonary artery. Indian J Thorac Cardiovasc Surg, 2021, 37(Suppl 1): 1-13.
11. Di Salvo G, Siblini G, Issa Z, et al. Left ventricular mechanics in patients with abnormal origin of the left main coronary artery from the pulmonary trunk late after successful repair. Cardiology, 2017, 136(2): 71-76.
12. Zhang C, Zhang H, Yan J, et al. Mid-term outcome for anomalous origin of the left coronary artery from the pulmonary artery. Heart Lung Circ, 2020, 29(5): 766-771.
13. Ma K, Wang L, Hua Z, et al. Outcomes of coronary transfer for anomalous origin of the left coronary artery from the pulmonary artery. Eur J Cardiothorac Surg, 2015, 47(4): 659-664.
14. Nasseri BA, Alexi-Meskishvili V, Nordmeyer S, et al. Predictors for the use of left ventricular assist devices in infants with anomalous left coronary artery from the pulmonary artery. Ann Thorac Surg, 2010, 90(2): 580-587.
15. Wang J, Wang C, Wang Y, et al. Fluid overload in special pediatric cohorts with anomalous origin of the left coronary artery from the pulmonary artery following surgical repair. J Cardiothorac Vasc Anesth, 2020, 34(6): 1565-1572.
16. Gist KM, Henry BM, Borasino S, et al. Prophylactic peritoneal dialysis after the arterial switch operation: A retrospective cohort study. Ann Thorac Surg, 2021, 111(2): 655-661.
17. Wu Y, Zhao T, Li Y, et al. Use of extracorporeal membrane oxygenation after congenital heart disease repair: A systematic review and meta-analysis. Front Cardiovasc Med, 2020, 7: 583289.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of the risk factors for extracorporeal membrane oxygenation use after surgical repair in patients with anomalous origin of the left coronary artery from the pulmonary artery combined with severe left ventricular dysfunction

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