Adult coronary artery bypass grafting by congenital surgeons-a propensity matched analysis
Filippo Rapetto1,2, Vito D Bruno1, Cha Rajakaruna1
1Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK.
Insights
Adults with congenital heart disease increasingly need surgical myocardial revascularization. Coronary artery bypass grafting (CABG) performed by congenital cardiac surgeons yields results comparable to adult surgeons, ensuring safe and effective treatment.
Area of Science:
- Cardiovascular Surgery
- Adult Congenital Heart Disease
- Cardiac Surgery Outcomes
Background:
- Adult congenital heart disease (ACHD) patients often require complex cardiac procedures.
- Surgical myocardial revascularization, such as coronary artery bypass grafting (CABG), is becoming more common in ACHD.
- The expertise of congenital cardiac surgeons in performing CABG on adults is an area of ongoing investigation.
Purpose of the Study:
- To evaluate the outcomes of coronary artery bypass grafting (CABG) in adult patients with congenital heart disease.
- To compare the safety and efficacy of CABG performed by congenital cardiac surgeons versus adult cardiac surgeons.
- To assess the feasibility of surgical myocardial revascularization in a diverse ACHD population.
Main Methods:
- Retrospective, single-centre study including adults undergoing isolated or combined CABG from 2004 to 2017.
- Analysis of early and late outcomes for the entire cohort.
- Propensity score matching to compare outcomes between congenital and adult surgeons for isolated CABG.
Main Results:
- Overall early mortality was 1.2%, with 4.5% re-exploration for bleeding.
- One-year and 5-year survival rates were 97.5% and 88.0%, respectively.
- Propensity-matched analysis showed no significant differences in early mortality, re-exploration, or graft use between congenital and adult surgeons.
Conclusions:
- Surgical myocardial revascularization is a viable option for adult congenital heart disease patients across various clinical scenarios.
- Congenital cardiac surgeons can safely perform CABG in adults, achieving outcomes comparable to experienced adult cardiac surgeons.
- This study supports the integration of CABG expertise within congenital cardiac surgery programs to manage ACHD patients effectively.
Objectives:
Surgical myocardial revascularization will be increasingly needed in adult patients with congenital heart disease. We investigated the results of coronary artery bypass grafting (CABG) performed on adults by congenital cardiac surgeons at our institution.
Methods:
We conducted a retrospective, single-centre study. Adults undergoing isolated or combined CABG from 2004 to 2017 were included. Early and late outcomes were analyzed for the whole cohort. Furthermore, a propensity matched analysis was conducted comparing the results of isolated CABG between congenital and adult surgeons.
Results:
A total of 514 and 113 patients had isolated and combined CABG for acquired heart disease, respectively. A total of 33 patients had myocardial revascularization at the time of surgery for congenital heart disease. Overall early mortality was 1.2%, the rate of re-exploration for bleeding was 4.5%, and an internal mammary artery to left anterior descending artery graft was used in 85.6% patients. One-year survival was 97.5% (96.2-98.8%), and 5-year survival was 88.0% (84.8-91.3%). After propensity matching (468 pairs), early mortality (0.6% vs 1.2%, P = 0.51), re-exploration for bleeding (3.6% vs 3.0%, P = 0.72), use of internal mammary artery to left anterior descending artery graft (92.7% vs 91.9%, P = 0.70) and late survival did not differ between congenital surgeons and adult surgeons, respectively.
Conclusions:
Surgical myocardial revascularization can be required for adult congenital patients in a broad spectrum of clinical situations. Despite lower volumes, congenital cardiac surgeons perform CABG safely and with results that are comparable to those of the adult surgeons at our centre.
