Factors Associated With Adverse Outcomes After Repair of Anomalous Coronary From Pulmonary Artery

Ann Thorac Surg. 2019 Sep;108(3):785-791. doi: 10.1016/j.athoracsur.2019.04.031. Epub 2019 May 29.

Abstract

Background: Successful repair of anomalous origin of coronary artery from the pulmonary artery (ACAPA) is generally associated with a good prognosis. However, risk factors for poor postoperative outcomes have not been well characterized. This study used a multicenter data set to determine predictors of mortality after ACAPA repair.

Methods: A retrospective analysis was performed using The Society of Thoracic Surgeons Congenital Heart Surgery Database's Participant User File. After identification of all patients with ACAPA who underwent repair from 2007 to 2016, demographics, preoperative and intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors. The primary outcomes included (1) in-hospital mortality and (2) the need for postoperative extracorporeal membrane oxygenation (ECMO) support. Multivariable logistic regression was used to determine preoperative and intraoperative risk factors for these outcomes.

Results: Of the 703 patients who underwent ACAPA repair, 20 (2.8%) died during the same hospitalization. The odds of mortality were increased if preoperative shock was present (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.4 to 15.1; P = .01) and if postoperative ECMO was required (OR, 11.8; 95% CI, 3.6 to 38.4; P < .001). The odds of postoperative ECMO use were increased if preoperative shock was present (OR, 3.6; 95% CI, 1.6 to 7.6; P = .001). Lower weight was also a risk factor for both mortality and postoperative ECMO.

Conclusions: Lower weight, preoperative shock, and postoperative ECMO use were identified as risk factors for in-hospital mortality in patients undergoing ACAPA repair. These important perioperative factors likely reflect the clinical severity of presentation and suggest a role for early consideration of postoperative mechanical circulatory support to improve outcomes.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Surgical Procedures / methods
  • Cardiac Surgical Procedures / mortality
  • Cause of Death
  • Cohort Studies
  • Coronary Vessel Anomalies / diagnostic imaging
  • Coronary Vessel Anomalies / mortality
  • Coronary Vessel Anomalies / surgery*
  • Databases, Factual
  • Education, Medical, Continuing
  • Extracorporeal Membrane Oxygenation / methods
  • Female
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery*
  • Hospital Mortality*
  • Humans
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Multivariate Analysis
  • North America
  • Postoperative Complications / mortality*
  • Postoperative Complications / physiopathology
  • Prognosis
  • Pulmonary Artery / abnormalities*
  • Pulmonary Artery / surgery
  • Retrospective Studies
  • Risk Assessment
  • Societies, Medical
  • Treatment Outcome