Format

Send to

Choose Destination
Heart. 2018 Sep;104(17):1417-1423. doi: 10.1136/heartjnl-2017-312652. Epub 2018 Feb 22.

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

Author information

1
Children's Heart Institute, Fairfax, Virginia, USA.
2
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
3
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
4
Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA.
5
Department of Pediatrics, Emory University, Atlanta, Georgia, USA.
6
Medical School, National and Kapodistrian University of Athens, Athens, Greece.
7
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
8
Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
9
Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
#
Contributed equally

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 (<18 years 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.

KEYWORDS:

congenital heart disease; congenital heart disease surgery

PMID:
29472291
PMCID:
PMC6092219
DOI:
10.1136/heartjnl-2017-312652
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center