Outcomes after surgical coronary artery revascularisation in children with congenital heart disease.

Document Type

Article

Publication Date

9-2018

Identifier

DOI: 10.1136/heartjnl-2017-312652; PMCID: PMC6092219

Abstract

OBJECTIVE: Surgical coronary revascularisation in children with congenital heart disease (CHD) is a rare event for which limited information is available. In this study, we review the indications and outcomes of surgical coronary revascularisation from the Pediatric Cardiac Care Consortium, a large US-based multicentre registry of interventions for CHD.

METHODS: This is a retrospective cohort study of children (old) with CHD who underwent surgical coronary revascularisation between 1982 and 2011. In-hospital mortality and graft patency data were obtained from the registry. Long-term transplant-free survival through 2014 was achieved for patients with adequate identifiers via linkage with the US National Death Index and the Organ Procurement and Transplantation Network.

RESULTS: Coronary revascularisation was accomplished by bypass grafting (n=72, median age 6.8 years, range 3 days-17.4 years) or other operations (n=65, median age 2.6 years, range 5 days-16.7 years) in 137 patients. Most revascularisations were related to the aortic root (61.3%) or coronary anomalies (27.7%), but 10.9% of them were unrelated to either of them. Twenty in-hospital deaths occurred, 70% of them after urgent 'rescue' revascularisation in association with another operation. Long-term outcomes were available by external linkage for 54 patients surviving to hospital discharge (median follow-up time 15.0 years, max follow-up 29.8 years) with a 15-year transplant-free survival of 91% (95% CI 83% to 99%).

CONCLUSIONS: Surgical coronary revascularisation can be performed in children with CHD with acceptable immediate and long-term survival. Outcomes are dependent on indication, with the highest mortality in rescue procedures.

Journal Title

Heart (British Cardiac Society)

Volume

104

Issue

17

First Page

1417

Last Page

1423

MeSH Keywords

Adolescent; Child, Preschool; Female; Follow-Up Studies; Heart Defects, Congenital; Hospital Mortality; Humans; Infant, Newborn; Long Term Adverse Effects; Male; Myocardial Revascularization; Outcome and Process Assessment, Health Care; Registries; Retrospective Studies; Survival Analysis; United States

Keywords

congenital heart disease; congenital heart disease surgery

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