Management of mitral regurgitation at the time of repair for anomalous left coronary artery from the pulmonary artery: a propensity score-matched analysis

Presented During:

Sunday, May 15, 2022: 2:45 PM - 3:00 PM
Hynes Convention Center  
Posted Room Name: Room 302  

Abstract No:

2647 

Submission Type:

Abstract Submission 

Authors:

Wen Zhang (1), Renjie Hu (1), Qi Jiang (1), Hongbin Zhu (1), Lisheng Qiu (1), Wei Dong (1), Haibo Zhang (1)

Institutions:

(1) Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China

Submitting Author:

Wen Zhang  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine

Co-Author(s):

Renjie Hu  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine
Qi Jiang  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine
Hongbin Zhu  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine
Lisheng Qiu  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine
Wei Dong  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine
Haibo Zhang  
Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine

Presenting Author:

Wen Zhang  
N/A

Abstract:

Objective: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is frequently associated with significant mitral regurgitation (MR), but the management of MR at the time of ALCAPA repair is still the subject of debate.
Methods: All patients with ALCAPA who presented with >mild degree of MR at our institution between January 2008 and June 2020 were included in the retrospective study. Outcomes were compared between those who underwent concomitant mitral intervention and those who underwent ALCAPA repair alone. Propensity score matching for baseline characteristics, time courses of the postoperative MR grade and predictors for MR recovery were performed.
Results: Of 101 patients with >mild degree of MR, 66 patients (65%) underwent concomitant mitral intervention. Patients with concomitant mitral intervention had significant higher preoperative left ventricular ejection fraction (LVEF) and more severe grade of MR. There were no significant differences in survival and freedom from reoperation for MR in the unmatched cohort. Propensity score matching resulted in 32 well-matched pairs. Patients with concomitant mitral intervention had longer time for cardiopulmonary bypass and aortic cross-clamp compared to patients with ALCAPA repair alone, but the two matched groups were similar in terms of early mortality, duration of mechanical ventilation, intensive care unit stay and postoperative LVEF trajectories. At the last visit, MR grade showed significant improvement in both matched groups. In patients with concomitant mitral intervention, the probability of MR recovery was the greatest immediately after completion of surgery, but gradually decreased over time. In contrast, in patients without concomitant mitral intervention, the probability of recovery was steadily increased postoperatively but remained almost unchanged 1 year after surgery (Figure). Preoperative mitral valve annulus diameter z-score was the only predictor for postoperative MR recovery (p=0.044, HR 0.635, 95% CI 0.408-0.988).
Conclusions: Mitral intervention may not be generally required at the time of ALCAPA repair. However, although significant MR improvement can be achieved after surgery, MR grade may still not return to normal regardless of the mitral intervention strategy used at the initial repair.

CONGENTIAL:

Congenital Coronary Anomalies

Image or Table

Supporting Image: AATSabstract.jpg
 

Keywords - Congenital

Congenital Malformation - Anomalous Coronary Arteries
Mitral Valve - Mitral Valve