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Early and Mid-Term Outcomes of Coronary Artery Bypass Grafting in Adults With Congenital Heart Disease

Published:November 02, 2022DOI:https://doi.org/10.1053/j.semtcvs.2022.10.007
      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)
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