Coronary artery disease in adult congenital heart disease: Outcome after coronary artery bypass grafting

John M. Stulak, Joseph A. Dearani, Harold M. Burkhart, Naser M. Ammash, Sabrina D. Phillips, Hartzell V Schaff

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Atherosclerotic coronary artery disease may be seen during repair of adult congenital heart disease (ACHD). There are few data outlining outcomes of concomitant coronary artery bypass grafting (CABG) in these patients. Between February 1972 and August 2009, 122 patients (77 men) underwent concomitant CABG at the time of ACHD repair; median age was 64 years (range 40 to 85 years). Thirty patients (25%) had preoperative angina, 7 patients (6%) had previous myocardial infarction (MI), and 6 patients (5%) had previous percutaneous intervention. Most common primary cardiac diagnoses included secundum atrial septal defect (ASD) in 73 patients (60%), Ebstein's anomaly in 14 patients (11%), and partial anomalous pulmonary venous connection in 8 patients (7%). Operations included ASD repair in 78 patients (64%), tricuspid/pulmonary valve procedures in 23 patients (19%), and ventricular septal defect repair in 10 patients (8%). One bypass graft procedure was performed in 69 patients (57%), 2 bypass graft procedures were performed in 32 patients (26%), 3 bypass graft procedures were performed in 14 patients (11%), 4 bypass graft procedures were performed in 5 patients (4%), and 5 bypass graft procedures were performed in 2 patients (2%). There were 4 early deaths (3.3%). During a median follow-up of 6 years (maximum follow-up, 32 years), actuarial survival was 76% at 5 years and 56% at 10 years. In patients with left anterior descending (LAD) artery disease, survival was higher when a left internal mammary graft (LIMA) was used (5 years, 86% versus 66%; 10 years, 66% versus 36%; p < 0.05). Concomitant CABG may be required at the time of correction of ACHD. Survival is higher when a LIMA graft is used, and late functional outcome is good, with a low incidence of late angina and need for reintervention.

Original languageEnglish (US)
Pages (from-to)116-123
Number of pages8
JournalAnnals of Thoracic Surgery
Volume93
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Coronary Artery Bypass
Coronary Artery Disease
Heart Diseases
Transplants
Atrial Heart Septal Defects
Survival
Breast
Ebstein Anomaly
Pulmonary Valve
Tricuspid Valve
Ventricular Heart Septal Defects

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Coronary artery disease in adult congenital heart disease : Outcome after coronary artery bypass grafting. / Stulak, John M.; Dearani, Joseph A.; Burkhart, Harold M.; Ammash, Naser M.; Phillips, Sabrina D.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 93, No. 1, 01.2012, p. 116-123.

Research output: Contribution to journalArticle

Stulak, John M. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Ammash, Naser M. ; Phillips, Sabrina D. ; Schaff, Hartzell V. / Coronary artery disease in adult congenital heart disease : Outcome after coronary artery bypass grafting. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 1. pp. 116-123.
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