Coronary artery bypass grafting in adults with congenital heart disease
Yong-Chao Cui1, Xing-Hai Hao, Fang-Jiong Huang
1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Surgical intervention for adults with congenital heart disease (CHD) and coronary artery disease (CAD) is safe and effective. Off-pump coronary artery bypass grafting (OPCAB) with device closure of atrial septal defects (ASD) is a viable option for select patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Adult Congenital Heart Disease
Background:
- Adults with congenital heart disease (CHD) and coronary artery disease (CAD) present unique clinical challenges.
- Surgical management of combined CHD and CAD is rarely reported.
Purpose of the Study:
- To evaluate the outcomes of concomitant surgical intervention for adults with CHD and CAD.
Main Methods:
- 29 adult patients underwent simultaneous coronary artery bypass grafting (CABG) and CHD correction.
- Congenital defects included atrial septal defect (ASD), ventricular septal defect, atrioventricular septal defect, and cor triatriatum.
- Coronary artery disease severity varied, with some patients undergoing off-pump coronary artery bypass grafting (OPCAB) and intraoperative ASD device closure.
Main Results:
- One patient (3.4%) died due to pulmonary infection and multiorgan failure.
- Follow-up ranged from 2 to 89 months (mean 42 months).
- OPCAB with intraoperative ASD device closure in six patients resulted in no complications.
Conclusions:
- Concomitant surgery for adult CHD and CAD is safe and effective.
- OPCAB with intraoperative ASD device closure is a reasonable approach for selected patients.
Background:
Adults with congenital heart disease (CHD) and coronary artery disease (CAD) have unique clinical manifestation due to the coexistence of intracardiac anomalies and CAD. Case reports are rare in surgical management of CHD combined with CAD. Our goal is to study the outcome of surgical intervention of CHD and CAD concomitantly.
Methods:
From February 2002 to August 2009, 29 adult patients underwent coronary artery bypass grafting (CABG) and surgical correction of CHD concomitantly. Congenital cardiac anomalies include atrial septal defect (ASD) in 21 cases, ventricular septal defect in four cases, atrioventricular septal defect in three cases, and cor triatriatum in one case. Coronary angiography demonstrated: one-vessel disease in 10 cases, two-vessel disease in 11 cases, and three-vessel disease in eight cases. Coronary revascularization and intracardiac anomalies were corrected with cardiopulmonary bypass in 23 cases. There were six patients who had off-pump coronary artery pass grafting (OPCAB) and intraoperative device closure of ASD.
Results:
One patient died of pulmonary infection and multiorgan failure. Follow-up time was from 2 to 89 months (mean, 42 ± 25 months). One patient with recurrent angina did not need intervention of the revascularization. Six patients who acquired OPCAB and intraoperative device closure of ASD had no complications after surgery.
Conclusions:
Surgery for adult patients who had CHD with CAD was a safe and effective management. OPCAB with intraoperative device closure of ASD was a reasonable approach for some selective patients.
