Reoperation and Mechanical Circulatory Support After Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: A Twenty-Year Experience

Aortic Implantation of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: Long-Term Outcomes

“…However, in our study of patients with a similar median age, only 1 of 13 patients with severe LV dysfunction and an LVEDD greater than 4.0 cm required ECMO. Consistent with the findings of others, postoperative mechanical support was not required in older patients [20,30,31].…”

“…Despite MR not being associated with early or late mortality, Nasseri and associates [30] noted that patients requiring mechanical assistance did have a higher rate of severe preoperative MR although this difference did not achieve statistical significance. Additionally, in a study by Imamura and colleagues [20], all patients who required ECMO also required reoperations, predominantly for MR. In the study by del Nido and coworkers [31], 7 of 31 patients required ECMO and of the 5 ECMO survivors, 2 required reoperation for MR.…”

“…Repair of ALCAPA can be accomplished without early or late mortality [16,[18][19][20][21]. Coronary transfer has been shown to be associated with superior long-term survival and freedom from reoperation [22].…”

What other anomalies? Failure to wean post ventricular septal defect repair secondary to anomalous origin of the left coronary artery from the pulmonary artery

“…The use of ECMO postoperatively to allow ventricular recovery is well described, with run durations ranging from 2 to 10 days (3). However, patients who require mechanical support postoperatively appear to be at higher risk for transplantation or reoperation, usually for mitral regurgitation (4). As mentioned, the diagnosis is most often made by echocardiography and transient oxygen administration during the study to reduce pulmonary artery pressure and enhance flow reversal detected on Doppler may be useful.…”

Use of the Batista Procedure to Discontinue Bypass Following Aortic Reimplantation of an Anomalous Left Coronary Artery

“…LV assist devices (LVAD) and extracorporeal membrane oxygenation (ECMO) constitute invaluable adjuncts for keeping these patients alive after surgical correction (10% to 20% require its use) 3 . Imamura et al have reported a mortality of 12.5% in the era before ECMO in their institution compared with 6% following ECMO support 4 . In centers where these devices still are not readily available, the Batista operation must be considered as a salvage procedure to improve myocardial efficiency.…”