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Original research article
Outcomes after surgical coronary artery revascularisation in children with congenital heart disease
  1. Kalpana Thammineni1,
  2. Jeffrey M Vinocur2,
  3. Brian Harvey3,
  4. Jeremiah S Menk4,
  5. Michael Scott Kelleman5,
  6. Anna-Maria Korakiti6,
  7. Amanda S Thomas5,
  8. James H Moller7,
  9. James D St Louis8,
  10. Lazaros K Kochilas5,9
  1. 1Children’s Heart Institute, Fairfax, Virginia, USA
  2. 2Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  3. 3Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5Department of Pediatrics, Emory University, Atlanta, Georgia, USA
  6. 6Medical School, National and Kapodistrian University of Athens, Athens, Greece
  7. 7Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
  8. 8Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
  9. 9Sibley Heart Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
  1. Correspondence to Dr Lazaros K Kochilas, Department of Pediatrics, Emory University, Atlanta, GA 30322, USA; lazaros.Kochilas{at}emory.edu

Abstract

Objective Surgical coronary revascularisation in children with congenital heart disease (CHD) is a rare event for which limited information is available. In this study, we review the indications and outcomes of surgical coronary revascularisation from the Pediatric Cardiac Care Consortium, a large US-based multicentre registry of interventions for CHD.

Methods This is a retrospective cohort study of children (<18 years old) with CHD who underwent surgical coronary revascularisation between 1982 and 2011. In-hospital mortality and graft patency data were obtained from the registry. Long-term transplant-free survival through 2014 was achieved for patients with adequate identifiers via linkage with the US National Death Index and the Organ Procurement and Transplantation Network.

Results Coronary revascularisation was accomplished by bypass grafting (n=72, median age 6.8 years, range 3 days–17.4 years) or other operations (n=65, median age 2.6 years, range 5 days–16.7 years) in 137 patients. Most revascularisations were related to the aortic root (61.3%) or coronary anomalies (27.7%), but 10.9% of them were unrelated to either of them. Twenty in-hospital deaths occurred, 70% of them after urgent ‘rescue’ revascularisation in association with another operation. Long-term outcomes were available by external linkage for 54 patients surviving to hospital discharge (median follow-up time 15.0 years, max follow-up 29.8 years) with a 15-year transplant-free survival of 91% (95% CI 83% to 99%).

Conclusions Surgical coronary revascularisation can be performed in children with CHD with acceptable immediate and long-term survival. Outcomes are dependent on indication, with the highest mortality in rescue procedures.

  • congenital heart disease surgery
  • congenital heart disease

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Footnotes

  • KT and JMV contributed equally.

  • Contributors KT and JMV were critical to the development of this research question and together wrote the majority of the original draft for this manuscript. BH served a major role in the collection and quality control of data, and he provided review of and edits to the manuscript based on this knowledge. JSM, MSK and AST conducted the data analyses and formulated the presentation of these results. Each of these three also contributed to the writing of the Methods section and provided critical review of the rest of the manuscript. A-MK collected data through extraction of information from PDF files for patients involved in this study and provided important insight into the interpretation of results. JHM JDSL and LKK were instrumental in the PCCC study design, maintenance and linkage with other datasets. They each provided expertise in database knowledge as well as clinical perspectives in the formulation of this research question, interpretation of findings and the final presentation of results.

  • Funding This study was supported by National Heart, Lung, and Blood Institute R01 HL122392 and NIH CTSA Award UL1TR000114.

  • Disclaimer The data reported here have been supplied by UNOS (United Network for Organ Sharing) as the contractor for the Organ Procurement and Transplantation Network (OPTN). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US Government.

  • Competing interests None declared.

  • Ethics approval University of Minnesota IRB and Emory University IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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