The effects of two perfusion methods in the treatment of left coronary artery abnormality originated from pulmonary artery / 中华胸心血管外科杂志

ABSTRACT

Objective To investigate the applicate effects in the treatment of left coronary artery abnormality originated from pulmonary artery(ALCAPA) with two perfusion methods of Medium-low temperature-full flow and Low-temperature-low flow.Methods From April 2010 to August 2018, 51 children with ALCAPA were treated with direct coronary artery trans-plantation in Beijing Anzhen Hospital.According to the circulated perfusion method, All of cases were divided into two groupsthe Medium-low temperature full flow(group A) and Low-temperature low flow(group B); All patients underwent ALCAPA correct operation under general anesthesia by intravenous inhalation and extracorporeal circulation , and the combined cardiac malformations at the same period.Results The whole of 51 children, including 27 males and 24 females, the aweraged age was(29.19 ±19.43)months(8-36 months), the aweraged weight was(11.73 ±9.99)kg(7.4 -35.0 kg).The cardiotho-racic ratio(C/T) was 0.70 ±0.09.In group A, 24 patients, including 13 males and 11 females, the aweraged age 3 -36 (28.64 ±16.30) months, the aweraged weight 7.4-31.0(12.25 ±10.33) kg, and the cardiothoracic ratio(C/T) 0.71 ± 0.07.Group B included 27 patients, including 15 males and 12 females, the aweraged age 5-31(25.85 ±16.60) months, the aweraged weight 6.7-35.0(10.38 ±3.67)kg, and the cardiothoracic ratio(C/T) of 0.69 ±0.06.The postoperative ear-ly death were 5 cases in the whole group, there were 3 cases in group A and 2 cases in group B, all of them were died of low cardiac output syndrome.Extracorporeal membrane oxygenation(ECMO) support for 7 cases of 5 in group A and 2 in group B. There was no statistically significant difference in in-hospital mortality between the two groups(P >0.05).The Intraoperative extracorporeal circulation time, ascending aorta occlusion time, the number and amount of myocardial cold arrest fluid perfu-sion, postoperative extracorporeal circulation assistance time, the incidence of ventricular fibrillation, ICU residence time, and ventilator assistance time were significantly lower in group B than group A, all with statistically significant differences(P<0. 05).A total of 42 cases were followed up after the operation, the follow-up time 17(3-29) months and the left ventricular e-jection fraction increased from 0.53 ±0.15 to 0.66 ±0.14(P<0.05), there was no statistically significant difference between two groups.Conclusion The perfusion modes of Low-temperature-low flow in the correct operation of ALCAPA can effectively shorten the time of aortic occlusion , improve the effect of intraoperative myocardial protection , reduce intraoperative visual field return blood volume, and reduce postoperative low cardiac output.To improve the curative effect of operation.