The Influence of Pre-operative Mitral Regurgitation in Post Operative Recovery of Ventricular Function in Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA).

Abstract

We attempted to study the influence of pre-operative mitral regurgitation on the recovery of ventricular function in paediatric patients with repaired anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Eighty-eight patients under 18 years who underwent ALCAPA repair from 2003 to 2022 were included. Baseline clinical and echocardiographic data, including MR and left ventricular ejection fraction (LVEF), were recorded pre-operatively and at multiple post-operative follow-ups (discharge, 1 month, 6 months, 1 year, and annually thereafter). Friedman's Test and correlation/regression analyses were used to assess the impact of pre-operative MR on ventricular function recovery. The median age at surgery was 6 months(range 1-197), and the median hospital stay was 17 days. 56.81% of patients had moderate to severe MR pre-operatively, while only 25% had moderate to severe MR at 1-year follow-up. Mitral valve repair was performed in 44% of cases with significant MR. Pre-operative MR grades positively correlated with post-operative MR (ρ = 0.574, p < 0.001) and pre-operative LVEF correlated with post-operative LVEF (ρ = 0.698, p < 0.001). Linear regression analysis showed that patients with lesser MR had more change in LVEF (38 to 63.66%) than the moderate to severe MR group (42.22% to 66.38%, odd's ratio=-3.073, p = 0.024). Irrespective of severity of pre-operative MR, left ventricular function improved significantly after the surgical repair. Patients with pre-operative mild MR tended to experience more pronounced gains in LVEF following repair.