State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Thorac Surg. 2018 Dec;106(6):1860-1867. doi: 10.1016/j.athoracsur.2018.05.051. Epub 2018 Jun 19.
The outcomes of different repair strategies of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adolescent and adult patients are uncertain. The long-term outcomes of reimplantation and Takeuchi repair were compared in this study.
We conducted a retrospective review of data collected from patients receiving ALCAPA repair at our institute from January 2005 to December 2016. Short- and long-term outcomes of reimplantation and Takeuchi repair were compared.
A total of 50 consecutive patients underwent ALCAPA repair, with an average age of 31.6 ± 15.6 years and 66% women. No significant differences were found in short-term outcomes between the 2 groups. However, at a median of 65.7 months' follow-up, the major adverse cardiovascular event (MACE) (including all-cause death, admission due to heart failure, new-onset acute myocardial infarction, and repeated revascularization) rate of the Takeuchi repair group was significantly lower than that of the reimplantation group (hazard ratio, 0.21; 95% confidence interval, 0.04 to 0.97). Furthermore, the preoperative glucose level was significantly associated with increased MACE rate (hazard ratio, 10.82; 95% confidence interval, 1.20 to 97.54). Left ventricular end-diastolic diameter and ejection fraction significantly improved in both groups. However, mitral valvuloplasty did not predict long-term recovery of left ventricular function.
Although short-term outcomes were satisfactory in both groups, a higher MACE rate was observed in reimplantation group than Takeuchi repair group; mitral valvuloplasty was not significantly associated with improved prognosis and left ventricular reverse remodeling. Elevation of preoperative blood glucose level was significantly associated with increasing long-term MACE rate.
左冠状动脉异常起源于肺动脉（ALCAPA）在青少年和成年患者中的不同修复策略的结果尚不确定。本研究比较了再植入和 Takeuchi 修复的长期结果。
我们对 2005 年 1 月至 2016 年 12 月在我院接受 ALCAPA 修复的患者的数据进行了回顾性分析。比较了再植入和 Takeuchi 修复的短期和长期结果。
共 50 例连续患者接受了 ALCAPA 修复，平均年龄为 31.6±15.6 岁，女性占 66%。两组患者的短期结果无显著差异。然而，在中位随访 65.7 个月时，Takeuchi 修复组的主要不良心血管事件（MACE）（包括全因死亡、因心力衰竭入院、新发急性心肌梗死和再次血运重建）发生率明显低于再植入组（风险比，0.21；95%置信区间，0.04 至 0.97）。此外，术前血糖水平与 MACE 发生率增加显著相关（风险比，10.82；95%置信区间，1.20 至 97.54）。两组患者的左心室舒张末期直径和射血分数均显著改善。然而，二尖瓣成形术与左心室功能的长期恢复无关。
尽管两组的短期结果令人满意，但再植入组的 MACE 发生率高于 Takeuchi 修复组；二尖瓣成形术与改善预后和左心室逆重构无关。术前血糖水平升高与长期 MACE 发生率增加显著相关。
