Atherosclerotic coronary artery disease (CAD) is well-studied in acquired cardiac
diseases; however, little data exist regarding outcomes of adult congenital heart
disease (ACHD) with CAD. This study examined patients who underwent coronary artery
bypass grafting (CABG) during repair of ACHD. This was a retrospective study of patients
who underwent CABG for CAD concomitant with ACHD repair 1972-2021. Demographic information,
ACHD diagnosis, surgical history, operative details, and outcomes were analyzed. Data
are presented as median (interquartile range [IQR]). 157 patients were identified
with a median age of 63 (IQR 17) years. Left anterior descending (LAD) was the predominant
diseased artery (109 patients [69%]); of those 83 (76%) were treated with mammary
artery. 90 (57.3%) patients had 1 bypass, 42 (26.7%) 2, 19 (12%) 3, and 6 (3.8%) had
4. There has been no early mortality since 1988. There was no long-term survival difference
between the patients with LAD disease treated with mammary compared to vein (P = 0.68), but early mortality was higher in those treated with vein (10.3% vs 0%,
P = 0.018). Late recurrent angina was found in 18 patients (12%) and recurrent CAD
found in 17 patients (11%), with 16 patients (10%) requiring CAD reintervention. At
most recent follow-up (7.2 [IQR 11.4] years), 101 (64.3%) patients were deceased at
10 (IQR 13.1) years after surgery. Surgical revascularization for CAD may be necessary
during the treatment of ACHD, most commonly for LAD disease. Early mortality was low
in recent decades. Continued surveillance for recurrent CAD is required.
Keywords
Abbreviations:
ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program), ACHD (adult congenital heart disease), ASD (atrial septal defect), CVD (cardiovascular disease), CHD (congenital heart disease), CABG (coronary artery bypass grafting), CAD (coronary artery disease), IRB (institutional Review Board, IQR, interquartile range, LAD, Left anterior descending), LAVV (left atrioventricular valve, LIMA, left internal mammary artery), MI (myocardial infarction), NYHA (New York Heart Association), OM (obtuse marginal artery), PTCA (percutaneous transluminal coronary angioplasty), RCA (right coronary artery), RIMA (right internal mammary artery), RVOT (right ventricle outflow tract), SVG (saphenous vein graft), TV (Tricuspid valve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 02, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: none
Conflicts of Interest: none
IRB number: 21-003034
Meeting Presentations: Poster presentation on May 16th, at the 102nd annual AATS meeting in Boston.
Classifications: Congenital heart disease, Coronary Artery Bypass Graft, CHD, CABG
Poster exhibited at the AATS 102nd Annual Meeting, May 14-17, 2022, Boston, MA.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
