Anomalous origin of the left coronary artery from the pulmonary artery: Successful surgical strategy without assist devices
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Anomalous origin of the left coronary artery from the pulmonary artery: Successful surgical strategy without assist devices. / Backer, Carl L.; Hillman, Neal; Dodge-Khatami, Ali; Mavroudis, Constantine.
In: Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual, Vol. 3, 2000, p. 165-172.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -