Ann Thorac Surg 2007;83:1471
© 2007 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited commentary
Christian Pizarro, MD
Nemours Cardiac Center, Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19899
(Email: cpizarro{at}nemours.org).
Since the initial reports on the surgical management of anomalous left coronary artery from the pulmonary artery more than 40 years ago, several different surgical techniques have been used. More recently, and borrowing from experience with the arterial switch operation, restoration of a two-coronary circulation by direct reimplantation of the anomalous coronary artery seems to be the preferred surgical approach by most surgeons. Due to the low incidence of this anomaly and the usual practice of embracing one surgical approach, comparative studies looking at recovery of ventricular function, mitral insufficiency, and the need for reintervention afforded by different techniques are limited and lack meaningful follow-up.
The article by Lange and colleagues [1] provides an opportunity to characterize and compare the mid-term outcome of two surgical techniques in a sizable cohort of patients with well-documented assessments of ventricular and mitral function during follow up. The selective use of subclavia flap or coronary reimplantation approach allowed the inclusion of both techniques throughout the duration of the study period, eliminating some of the bias of noncontemporary comparisons.
With similar rates of early and late mortality, as well as recovery of ventricular function and mitral insufficiency it is not surprising that Langue and colleagues [1] have not abandoned one technique in favor of the other, but rather embraced the selective application of each of them. The ability to perform the subclavian flap repair with a shorter period of myocardial ischemia, cardiopulmonary bypass, and in selected cases no cardiopulmonary bypass at all seems very attractive, and this may provide an edge over the more conventional direct translocation technique.
The study by Lange and colleagues [1] provides possibly not only the longest follow-up on the subclavian artery anastomosis, but also a good argument to consider this technique in an era when direct coronary translocation seems to be the best approach.
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- Lange R, Vogt M, Hörer J, et al. Long-term results of repair of anomalous origin of the left coronary artery from the pulmonary artery Ann Thorac Surg 2007;83:1463-1471.[Abstract/Free Full Text]
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Long-Term Results of Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery
- Rüdiger Lange, Manfred Vogt, Jürgen Hörer, Julie Cleuziou, Andrea Menzel, Klaus Holper, John Hess, and Christian Schreiber
Ann. Thorac. Surg. 2007 83: 1463-1471.
[Abstract]
[Full Text]
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