Predictors of Short-term Outcomes Following Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in Chinese Children: A Case-Control Study

Abstract

Objective: To analyze the predictive factors associated with prolonged mechanical ventilation (PMV) and prolonged duration of inotropic support (PDIS) following anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) surgery with possible concomitant mitral valve procedure (MVP) in a relatively young population.

Design: A retrospective case-control study.

Setting: Fuwai hospital.

Participants: Pediatric patients with ALCAPA surgery from July 2010 to October 2017.

Interventions: None.

Measurements and main results: PMV was defined as a mechanical ventilation time ≥48 hours and PDIS as a duration of inotropic support ≥6 days. Univariate analysis, logistic regression analysis, and receiver operating characteristic curve analysis were used to identify independent predictors of PMV and PDIS. The independent predictors of PMV were found to be the left ventricular end-diastolic diameter z-score (LVEDDz), estimate of glomerular filtration rate (eGFR) and maximum vasoactive-inotropic score (VISm). The odds ratios and 95% confidence intervals for these predictors of PMV were the following: LVEDDz, 1.58 (1.19-2.09); eGFR, 0.96 (0.93-0.998); and VISm, 1.08 (1.01-1.17). The predictor of PDIS was LVEDDz at 1.65 (1.26-2.15). One patient died during hospitalization, and there was no reoperation. Thirty-seven patients received concomitant MVP with no hospital mortality. At discharge, mitral regurgitation (MR) had improved in all patients with MR. Patients with PMV were associated with more acute kidney injury, PDIS, and longer ICU and hospital stays.

Conclusions: In relatively young individuals who received ALCAPA surgery and possible concomitant MVP, short-term outcomes are favorable. Based on their experience bias, the authors recommend combining LVEDDz, eGFR, and VISm to predict PMV and applying LVEDDz for PDIS.

Keywords: Bland White Garland syndrome; congenital heart disease; left ventricular end-diastolic diameter z-score; prolonged duration of inotrope support; prolonged mechanical ventilation; risk factors.