Use of Temporary Left Ventricular Mechanical Circulatory Support after Repair of Anomalous Left Coronary Artery from the Pulmonary Artery

  • Dr Boris Nasseri, Deutsche Herzzentrum Berlin, Germany
  • Prof Vladimir Alexi-Meskishvili, Deutsche Herzzentrum Berlin, Germany
  • Dr Boris Schmitt, Deutsche Herzzentrum Berlin, Germany
  • Dr Sarah Eder, Deutsche Herzzentrum Berlin, Germany
  • Prof Yu-Guo Weng, Deutsche Herzzentrum Berlin, Germany
  • Dr Christof Stamm, Deutsche Herzzentrum Berlin, Germany
  • Prof Felix Berger, Deutsche Herzzentrum Berlin, Germany
  • Prof Roland Hetzer, Deutsche Herzzentrum Berlin, Germany

    • Background:
    Recovery of the left ventricular (LV) function after direct aortic re-implantation of the left coronary artery (LCA) for anomalous left coronary artery from pulmonary artery (ALCAPA) is well described. In some patients with severe LV-dysfunction temporary LV mechanical circulatory support (MCS) could be necessary. We report the mid-term results in 14 infants after ALCAPA-repair.
    Methods:
    Fourteen infants (median age 4.2, range 3-12 months) underwent direct aortic re-implantation of the LCA. Seven patients had severe mitral regurgitation, and 7 had severe LV-dysfunction. Six patients (LVAD-group) needed temporary MCS support after unsuccessful weaning from CPB.
    Results:
    All infants survived the operation, were alive at follow-up (median follow-up 10.4, range 1.4 - 17 years) and free of re-operation. Median preoperative LVEF (28 vs. 43%) and LV-FS (9 vs. 22%) were significant lower (p=0.0119 and p=0.0019), and LVEDD (47 vs. 32mm) and LVEDP (20 vs. 12mmHG) were significant higher in the LVAD-group compared with the Non-LVAD-group (p=0.0017 and p=0.0202). MCS support ranged from 4-12 days. Eleven patients had follow-up evaluation and all showed widely patent LCA anastomosis. LVEF had further improved compared to discharge with no significant different between groups (p=0.3015). MRI evaluation in 10 patients showed a perfusion deficits in 30%, wall motion abnormalities in 50% and scar formation in 40 % of the patients.
    Conclusion:
    Direct aortic re-implantation for ALCAPA even using temporary MCS can be performed with low mortality in infants. However, all patients need regular life-long evaluation after ALCAPA repair, especially after temporary MCS support due to myocardial damage.