Surgical Treatment of Anomalous Left Coronary Artery Originating from the Pulmonary Artery: A Single-Center Experience

Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomalous coronary artery origin disorder. Objective: We sought to summarize the clinical experience and prognostic characteristics of surgical treatment of ALCAPA. Methods: We retrospectively analyzed clinical information on patients who had ALCAPA and underwent surgery at our center from February 2016 to October 2023. Results: This comparative study of 23 ALCAPA patients (9 infants 1 year) demonstrated significant age-dependent outcomes. Infant patients exhibited markedly prolonged mechanical ventilation (183 ± 105.6 vs. 48.5 ± 62.2 min, p = 0.001) and hospitalization (30.8 ± 8.2 vs. 19.5 ± 6.2 days, p = 0.001), despite comparable operative times (p > 0.05). The perioperative mortality rate was 8.7% (2/23). Early postoperative mortality showed a non-significant trend in infants (22.2% vs. 0%, p = 0.11). Serial follow-up revealed substantial functional improvement, with abnormal left ventricular ejection fractions decreasing from 56.5% preoperatively to 14.3% at 1-month (p < 0.01), and severe mitral regurgitation declining from 34.7% to 14.3%. However, persistent left ventricular enlargement (81% at follow-up) and moderate mitral regurgitation (52.4%) were frequently observed. Conclusion: Surgical correction of ALCPA effectively restores coronary perfusion and reduces severe mitral regurgitation, though residual ventricular dilation and moderate valvular dysfunction persist in the short-term postoperative period. Nevertheless, the overall prognosis remains favorable when timely intervention is performed.