Prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery

Abstract

We sought to determine the value of preoperative left ventricular function and cardiopulmonary bypass parameters in the prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. Multivariate logistic regression was performed to identify a predictive model for postrepair left ventricular assist device implantation using the records of 27 patients who underwent direct aortic implantation of anomalous left coronary artery from the pulmonary artery from 1994 to 2011. Seven patients required left ventricular assist device implantation. Patients in group 1 (n = 20) were successfully weaned from cardiopulmonary bypass. Patients in group 2 (n = 7) required left ventricular assist device as a bridge to recovery. The 2 groups were similar in age, weight, and body surface area. Six of the 7 patients (85.7%) who required left ventricular assist device survived to hospital discharge. Hospital mortality was 3.7%. In the univariate model, fractional shortening, ejection fraction, and aortic crossclamp time were significantly associated with left ventricular assist device implantation (P = .026, .035, .031, respectively). In the multivariate analysis, the aortic crossclamp time was the only significant independent predictor of left ventricular assist device implantation. Aortic crossclamp time and fractional shortening together accounted for 80.9% (P < .001) of the variability in left ventricular assist device implantation and constituted the best predictive model: All patients requiring postrepair left ventricular assist device implantation had a fractional shortening less than 20% and an aortic crossclamp time greater than 56 minutes. The fractional shortening and aortic crossclamp time together predict 80.9% of the variability in postrepair left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. When preoperative left ventricular dysfunction is severe (fractional shortening < 20%), an aortic crossclamp time greater than 56 minutes is associated with a substantial risk of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery.