Cardiology in the young · 2025
Takeuchi repair for anomalous origin of the left coronary artery from the pulmonary artery: functional recovery and late complications in an 18-patient cohort.
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Tuncer Osman Nuri, Akhundova Mahsati, Levent Ertürk, Atay Yüksel
Аннотация
BACKGROUND: The Takeuchi procedure remains an important surgical option for treating anomalous origin of the left coronary artery from the pulmonary artery, particularly in cases where direct coronary reimplantation is not feasible. However, long-term outcome data in paediatric patients are limited.
METHODS: We retrospectively reviewed 18 paediatric patients who underwent Takeuchi repair between 2007 and 2023. Clinical characteristics, echocardiographic data, and outcomes-including survival, ventricular function, mitral regurgitation, and reintervention-were analysed. Kaplan-Meier analysis was used to assess survival and freedom from reintervention, and paired comparisons were evaluated using the Wilcoxon signed-rank test.
RESULTS: The median age at surgery was 6 months (range: 25 days to 12 years). Preoperative left ventricular ejection fraction was significantly depressed (median 23.5%), and mitral regurgitation was present in all patients. There were two early deaths (11.1%), both in patients with severe heart failure. No late mortality was observed during a maximum follow-up of 10.9 years. All survivors achieved New York Heart Association class I status. Left ventricular ejection fraction improved significantly postoperatively (p < 0.0001), and mitral regurgitation grade also decreased significantly (p < 0.001), with 94.4% showing only mild residual mitral regurgitation. Reintervention occurred in three patients (16.7%) for pulmonary artery stenosis or baffle leak. Freedom from reintervention at 10.9 years was 66.7%.
CONCLUSION: The Takeuchi procedure offers excellent survival and functional recovery in paediatric anomalous origin of the left coronary artery from the pulmonary artery patients when coronary translocation is not feasible. Although late complications such as pulmonary artery stenosis or baffle leak can occur, outcomes remain favourable with appropriate follow-up.
METHODS: We retrospectively reviewed 18 paediatric patients who underwent Takeuchi repair between 2007 and 2023. Clinical characteristics, echocardiographic data, and outcomes-including survival, ventricular function, mitral regurgitation, and reintervention-were analysed. Kaplan-Meier analysis was used to assess survival and freedom from reintervention, and paired comparisons were evaluated using the Wilcoxon signed-rank test.
RESULTS: The median age at surgery was 6 months (range: 25 days to 12 years). Preoperative left ventricular ejection fraction was significantly depressed (median 23.5%), and mitral regurgitation was present in all patients. There were two early deaths (11.1%), both in patients with severe heart failure. No late mortality was observed during a maximum follow-up of 10.9 years. All survivors achieved New York Heart Association class I status. Left ventricular ejection fraction improved significantly postoperatively (p < 0.0001), and mitral regurgitation grade also decreased significantly (p < 0.001), with 94.4% showing only mild residual mitral regurgitation. Reintervention occurred in three patients (16.7%) for pulmonary artery stenosis or baffle leak. Freedom from reintervention at 10.9 years was 66.7%.
CONCLUSION: The Takeuchi procedure offers excellent survival and functional recovery in paediatric anomalous origin of the left coronary artery from the pulmonary artery patients when coronary translocation is not feasible. Although late complications such as pulmonary artery stenosis or baffle leak can occur, outcomes remain favourable with appropriate follow-up.
Предметные рубрики MeSH
HumansPulmonary ArteryRetrospective StudiesFemaleMaleInfantChild, PreschoolChildCardiac Surgical ProceduresRecovery of FunctionPostoperative ComplicationsInfant, NewbornEchocardiographyFollow-Up StudiesCoronary Vessel AnomaliesStroke VolumeTreatment OutcomeCoronary VesselsVentricular Function, LeftMitral Valve InsufficiencyAnomalous Left Coronary Artery