Abstract
ObjectivesTranscatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited.MethodsWe retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups.ResultsIn total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up.ConclusionsTCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.
Highlights
Congenital coronary artery fistula (CCAF) is a rare congenital anomaly with a connection between coronary arteries and a cardiac chamber or intrathoracic great vessel
CCAF diagnosis was confirmed by preoperative transthoracic echocardiography (TTE), coronary computed tomographic angiography (CCTA) or selective coronary angiography (SCAG) as appropriate
Of the 121 pediatric patients undergoing CCAF closure between January 2002 and December 2017, 63(52.1%) underwent transcatheter closure (TCC), and 58(47.9%) underwent Surgical closure (SC). 114 (94.2%) patients completed at least 1 year follow-up and the median follow-up duration was 6.9 years (IQR 3.4–10.6 years)
Summary
Congenital coronary artery fistula (CCAF) is a rare congenital anomaly with a connection between coronary arteries and a cardiac chamber or intrathoracic great vessel. Compared to TCC, SC has a historically higher successful rate for fistula closure. SC requires cardiopulmonary bypass and median sternotomy, and these invasive procedures are associated with increased risk of complications such as infection and bleeding [6,7,8]. Reidy et al [9] reported on the first successful case of CCAF closure using TCC in 1983. TCC has procedures-related complications, including arrhythmia, myocardial ischemia and valves injury. Few studies have compared the efficacy and safety of these two procedures for CCAF therapy in pediatric patients. The aim of our current study was to evaluate and compare the successful rate and mid-term of procedure-related complications of these two procedures for CCAF therapy
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