Thorac Cardiovasc Surg 2014; 62 - OP114
DOI: 10.1055/s-0034-1367188

Mid-term results after repair of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA): Takeuchi repair vs coronary transfer

A. Neumann 1, D. Böthig 2, D. Bobylev 1, S. Sarikouch 3, L. Meschenmoser 1, T. Breymann 1, M. Westhoff-Bleck 4, M. Scheid 5, I. Tzanavaros 5, H. Bertram 2, P. Beerbaum 2, A. Haverich 1, A. Horke 1
  • 1Medizinische Hochschule Hannover, Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Germany
  • 2Medizinische Hochschule Hannover, Pädiatrische Kardiologie und Intensivmedizin, Hannover, Germany
  • 3Medizinische Hochschule Hannover, Hannover, Germany
  • 4Medizinische Hochschule Hannover, Kardiologie und Angiologie, Hannover, Germany
  • 5Sana Herzchirurgie, Zentrum für Angeborene Herzfehler, Stuttgart, Germany

Objectives: We evaluated mid-term results of two different repair strategies of Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA) in two surgical centers.

Methods: Between 1980 and 2013, 30 patients (median age 0.4 years, range 0.05-37.6 years) underwent ALCAPA repair. Sixteen patients were treated with coronary transfer, nine underwent Takeuchi repair (creation of an intrapulmonary tunnel) and five were treated with other procedures (tubular extension technique or ligation). One mitral valve was repaired during primary ALCAPA surgery. Median follow-up was 6.0 years (0.06-24.3 years), total follow-up time 245 years.

Results: None of the patients treated with a coronary transfer or a Takeuchi repair died. One moribund patient who received coronary ligation in the 1980s died perioperatively. Eighteen years freedom from reoperation was 70% for patients treated with coronary transfer. For patients with Takeuchi repair, 9 year freedom from reoperation was 70% (p = 0.27). At last follow-up, left ventricular enddiastolic diameter and function (mean FS 36%) was normal in all patients. All patients with a coronary transfer were in NYHA class I at last follow-up, one patient with a Takeuchi repair was in NYHA class II, the others were in NYHA class I as well. Eight years after Takeuchi repair, 81% of the patients suffered from at least moderate pulmonary regurgitation- in contrast to 0% after coronary transfer (p < 0.001). In all patients operated under one year of age, mitral regurgitation was absent or trivial at last follow-up, while 4 (36%) (p < 0.01) of the 11 patients operated later developed or kept at least moderate mitral regurgitation. One of them needed mitral valve replacement.

Conclusions: Survival rates and midterm left ventricular function were excellent for both surgical strategies. Takeuchi repair, however, led to significant pulmonary regurgitation. Mitral regurgitation resolved in all patients operated during their first year of life independent from the type of repair.