Long-term results after repair of anomalous origin of left coronary artery from the pulmonary artery: Takeuchi repair versus coronary transfer.

OBJECTIVES: We evaluated long-term results of two different repair strategies of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) in two German surgical centres.

METHODS: We performed a retrospective review of patients who underwent ALCAPA repair between November 1980 and October 2012. Ventricular function was assessed by standardized transthoracic echocardiographic studies.

RESULTS: A total of 30 patients with a median age of 0.4 years (range 0.05-37.6 years) underwent ALCAPA repair. Nineteen patients received coronary transfer, 9 underwent Takeuchi repair (creation of an intrapulmonary tunnel) and 2 were treated by closure of the ALCAPA. There was one concomitant mitral valve repair. The total follow-up was 244.8 years with a mean follow-up of 8.16 ± 6.7 years (range 0.06-24.3 years). There was no late mortality. None of the patients treated with coronary transfer or Takeuchi repair died. One moribund patient who received coronary ligation in the 1980s died perioperatively. The 10-year rate of freedom from reoperation was 94.1% for patients treated with coronary transfer. For patients with Takeuchi repair, the 10-year rate of freedom from reoperation was 71.1% (P = 0.146). At last follow-up, left ventricular end-diastolic diameter (LVEDD) and function measured by fractional shortening was normal in all patients.The mean shortening fraction improved from 20.25 ± 10.86% to 35.7 ± 4.8%, with the most remarkable change taking place in the first year, and the mean LVEDD indexed to normal improved from 42 ± 34% above normal values preoperatively to 3 ± 12% at the last follow-up (P < 0.01). The number of patients with moderate-to-severe mitral regurgitation (MR) improved from 50% to 6.7% (2 of 30) at the last follow-up. In all children receiving ALCAPA repair under the age of 6 months, MR was absent or trivial at the last follow-up.Eight years after Takeuchi repair, 79.9% of these patients suffered from at least moderate pulmonary regurgitation, in contrast to 0% after coronary transfer (P < 0.001).

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