Anomalous origin of the left coronary artery from the pulmonary artery: Successful surgical strategy without assist devices

TY - JOUR

T1 - Anomalous origin of the left coronary artery from the pulmonary artery: Successful surgical strategy without assist devices

AU - Backer, Carl L.

AU - Hillman, Neal

AU - Dodge-Khatami, Ali

AU - Mavroudis, Constantine

PY - 2000

Y1 - 2000

N2 - The objective of this review was to analyze a surgical strategy for children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) where aortic implantation was successful without the use of extracorporeal membrane oxygenation (ECMO) or left ventricular assist device (LVAD). From 1989 through 1999, 16 consecutive children underwent aortic implantation for ALCAPA. Median age was 0.45 years. Surgical strategy included bicaval venous cannulation, LV vent, moderate systemic hypothermia (28 degrees C), antegrade cardioplegia with pulmonary artery (PA) occlusion, PA transection, aortic implantation with a large "button" of PA, PA reconstruction with pericardium, intraoperative transesophageal echocardiography, and inotropic support with dopamine, dobutamine, and milrinone. All patients survived. No patient was placed on ECMO or LVAD. Mean cardiopulmonary bypass (CPB) time was 152 +/- 41 minutes. Mean aortic cross-clamp time was 46 +/- 13 minutes. Mean time from cross-clamp removal to CPB off ("weaning" time) was 58 +/- 20 minutes. One patient had delayed sternal closure. Only 2 patients required more than 10 &mgr;g/kg/minute of dopamine and dobutamine. Mean hospital stay was 29 +/- 25 days. One patient required outpatient inotropic support for 5 months. Although ECMO or LVAD may be necessary for some ALCAPA patients, we describe a surgical strategy of aortic implantation that was successful without the use of assist devices. Copyright 2000 by W.B. Saunders Company

AB - The objective of this review was to analyze a surgical strategy for children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) where aortic implantation was successful without the use of extracorporeal membrane oxygenation (ECMO) or left ventricular assist device (LVAD). From 1989 through 1999, 16 consecutive children underwent aortic implantation for ALCAPA. Median age was 0.45 years. Surgical strategy included bicaval venous cannulation, LV vent, moderate systemic hypothermia (28 degrees C), antegrade cardioplegia with pulmonary artery (PA) occlusion, PA transection, aortic implantation with a large "button" of PA, PA reconstruction with pericardium, intraoperative transesophageal echocardiography, and inotropic support with dopamine, dobutamine, and milrinone. All patients survived. No patient was placed on ECMO or LVAD. Mean cardiopulmonary bypass (CPB) time was 152 +/- 41 minutes. Mean aortic cross-clamp time was 46 +/- 13 minutes. Mean time from cross-clamp removal to CPB off ("weaning" time) was 58 +/- 20 minutes. One patient had delayed sternal closure. Only 2 patients required more than 10 &mgr;g/kg/minute of dopamine and dobutamine. Mean hospital stay was 29 +/- 25 days. One patient required outpatient inotropic support for 5 months. Although ECMO or LVAD may be necessary for some ALCAPA patients, we describe a surgical strategy of aortic implantation that was successful without the use of assist devices. Copyright 2000 by W.B. Saunders Company

U2 - 10.1053/tc.2000.6516

DO - 10.1053/tc.2000.6516

M3 - SCORING: Journal article

C2 - 11486194

VL - 3

SP - 165

EP - 172

JO - Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual

JF - Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual

SN - 1092-9126

ER -