Coronary Artery Disease in Adult Congenital Heart Disease: Outcome After Coronary Artery Bypass Grafting

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.