Open Access

ARTICLE

Analysis of Relevant Factors Associated with Postoperative Recovery after Anomalous Origin of the Left Coronary Artery from Pulmonary Artery Surgery in Children

Jia Yuan^1,2,#, Yanxing Lv^2,#, Xinyuan Ding³, Yunyi Zeng¹, Li Ma⁴, Hang Yang¹, Lin Jiang¹, Kamil Bildebayev⁵, Boiko Yuliya Nikolaevna⁵, Na Zhou^1,*

1 Department of CICU, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
2 Department of Neonatology, Guangzhou Women and Children’s Medical Center, Liuzhou Hospital, Liuzhou, China
3 Department of Emergency, Women and Children’s Medical Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
4 Department of Cardiac Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
5 Department of Pediatric Cardiac Surgery, Center of Perinatology and Pediatric Cardica Surgery, Almaty, Kazakhstan

* Corresponding Author: Na Zhou. Email:
# These authors contributed equally to this work as the first author

Structural and Congenital Heart Disease 2026, 21(1), 3 https://doi.org/10.32604/schd.2026.076648

Received 24 November 2025; Accepted 06 March 2026; Issue published 31 March 2026

Abstract

Backgorund: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly of coronary artery anatomy, usually diagnosed in infancy, but adults may also be affected by this deformity. Objectives: The aim of this study is to examine long-term outcomes in patients with ALCAPA and analyze the relevant factors influencing postoperative outcomes. Methods: The records of patients with ALCAPA admitted from January 2015 to December 2024 were retrospectively reviewed. Clinical data of the patients were retrieved from the records. The follow-up data included mortality rates and complications. Kaplan-Meier survival curves were used to analyze the occurrence of death and reoperation during the follow-up of patients with ALCAPA, and the log-rank test was used for comparisons between groups. A Cox regression model was used to analyze the risk factors for adverse events in patients with clinical indicators of an unfavorable prognosis. Results: 48 patients met the study criteria. Postoperative death or reoperation was defined as an unfavorable prognosis. Patients were divided into two groups: favorable prognosis (n = 41) and unfavorable prognosis (n = 7). The differences among the Kaplan–Meier survival curves for the different subgroups were statistically significant. Feeding difficulties (p < 0.001), preoperative left ventricular end-diastolic diameter (LVEDD) Z score (p = 0.049), preoperative mechanical ventilation (p < 0.001), preoperative vasoactive drugs (p < 0.001), ECMO (p < 0.001), and delayed sternal closure (p < 0.001) were associated with an unfavorable prognosis. Multivariate Cox proportional hazard analysis revealed that preoperative LVEF (HR: 0.711; 95% CI: 0.542–0.932; p = 0.013), CPB time (HR: 1.021; 95% CI: 1.003–1.04; p = 0.022) and length of stay (HR: 1.064; 95% CI: 1.015–1.116; p = 0.01) were associated with an unfavorable prognosis in patients, and age at surgery (HR: 1.092; 95% CI: 0.991–1.203; p = 0.077) was closely related to an unfavorable prognosis. Conclusions: A younger surgical age, a reduced preoperative LVEF, a longer CPB time, and a longer length of stay were associated with an unfavorable prognosis in this cohort.

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