TY - JOUR
T1 - Factors Associated With Adverse Outcomes After Repair of Anomalous Coronary From Pulmonary Artery
AU - Straka, Nadine
AU - Gauvreau, Kimberlee
AU - Allan, Catherine
AU - Jacobs, Marshall L.
AU - Pasquali, Sara K.
AU - Jacobs, Jeffrey P.
AU - Mayer, John E.
AU - Quinonez, Luis
AU - Newburger, Jane W.
AU - Thiagarajan, Ravi
AU - Nathan, Meena
N1 - Publisher Copyright:
© 2019 The Society of Thoracic Surgeons
PY - 2019/9
Y1 - 2019/9
N2 - Background: Successful repair of anomalous origin of coronary artery from the pulmonary artery (ACAPA) is generally associated with a good prognosis. However, risk factors for poor postoperative outcomes have not been well characterized. This study used a multicenter data set to determine predictors of mortality after ACAPA repair. Methods: A retrospective analysis was performed using The Society of Thoracic Surgeons Congenital Heart Surgery Database's Participant User File. After identification of all patients with ACAPA who underwent repair from 2007 to 2016, demographics, preoperative and intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors. The primary outcomes included (1) in-hospital mortality and (2) the need for postoperative extracorporeal membrane oxygenation (ECMO) support. Multivariable logistic regression was used to determine preoperative and intraoperative risk factors for these outcomes. Results: Of the 703 patients who underwent ACAPA repair, 20 (2.8%) died during the same hospitalization. The odds of mortality were increased if preoperative shock was present (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.4 to 15.1; P =.01) and if postoperative ECMO was required (OR, 11.8; 95% CI, 3.6 to 38.4; P <.001). The odds of postoperative ECMO use were increased if preoperative shock was present (OR, 3.6; 95% CI, 1.6 to 7.6; P =.001). Lower weight was also a risk factor for both mortality and postoperative ECMO. Conclusions: Lower weight, preoperative shock, and postoperative ECMO use were identified as risk factors for in-hospital mortality in patients undergoing ACAPA repair. These important perioperative factors likely reflect the clinical severity of presentation and suggest a role for early consideration of postoperative mechanical circulatory support to improve outcomes.
AB - Background: Successful repair of anomalous origin of coronary artery from the pulmonary artery (ACAPA) is generally associated with a good prognosis. However, risk factors for poor postoperative outcomes have not been well characterized. This study used a multicenter data set to determine predictors of mortality after ACAPA repair. Methods: A retrospective analysis was performed using The Society of Thoracic Surgeons Congenital Heart Surgery Database's Participant User File. After identification of all patients with ACAPA who underwent repair from 2007 to 2016, demographics, preoperative and intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors. The primary outcomes included (1) in-hospital mortality and (2) the need for postoperative extracorporeal membrane oxygenation (ECMO) support. Multivariable logistic regression was used to determine preoperative and intraoperative risk factors for these outcomes. Results: Of the 703 patients who underwent ACAPA repair, 20 (2.8%) died during the same hospitalization. The odds of mortality were increased if preoperative shock was present (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.4 to 15.1; P =.01) and if postoperative ECMO was required (OR, 11.8; 95% CI, 3.6 to 38.4; P <.001). The odds of postoperative ECMO use were increased if preoperative shock was present (OR, 3.6; 95% CI, 1.6 to 7.6; P =.001). Lower weight was also a risk factor for both mortality and postoperative ECMO. Conclusions: Lower weight, preoperative shock, and postoperative ECMO use were identified as risk factors for in-hospital mortality in patients undergoing ACAPA repair. These important perioperative factors likely reflect the clinical severity of presentation and suggest a role for early consideration of postoperative mechanical circulatory support to improve outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85070094975&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070094975&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2019.04.031
DO - 10.1016/j.athoracsur.2019.04.031
M3 - Article
C2 - 31152733
AN - SCOPUS:85070094975
SN - 0003-4975
VL - 108
SP - 785
EP - 791
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -