Coronary Artery Lesions Are Associated With Adverse Cardiac Events In Children Undergoing Supravalvular Aortic Stenosis Repair
shuhua luo, christoph haller, Lynne Nield, Rachel Parker, Luc Mertens, Mimi Xiaoming Deng, Jayme Varenbut, Chunbo steve Fan, Maruti Haranal, Glen S. Van Arsdell, Osami Honjo.
Hospital for Sick Children, Toronto, ON, Canada.
Background To assess the prevalence and characteristics of coronary artery(CA) lesions in patients with supravalvular aortic stenosis(SVAS), and to analyze the impacts of CA lesions on postoperative major adverse cardiac event (MACE). Methods 51 consecutive patients with SVAS between 2000-2017 were included. CA lesions were diagnosed by the catheterization, echocardiogram and operative notes. The association between risk factors and postoperative ST-segment change and MACE was analyzed using logistic regression and Fisher-test.Results A total of 48 CA lesions were identified in 27 patients (53%). The prominent ostial ridge (Type I) was the most common lesion (n=30, 62.5%), followed by a small ostium with (IIIB) or without (IIIA) diffuse long segment CA stenosis (n=15, 31.2%), and adhesion of the coronary-cusp (Type II) (n=3, 6.3%). There were 54 concomitant coronary procedures including 43 primary corrections and 11 revisions. Postoperative MACE occurred in 9 patients (17.6%), including deaths(n=3), ECMO(n=4) and ventricular arrhythmias(n=6). Twenty-two patients(43.1%) had ST-segment changes, including early transient(n=13) and persistent change(n=9). Type III CA lesions was associated with persistent ST-segment change (p=0.04) and independently predicted the occurrence of MACE (p=0.02). Patients with CA lesions were at risk of right CA distortion by the patch (p=0.04). ConclusionsThe incidence of ST-segment changes and MACE is relatively high after SVAS repair. A small ostium with or without diffuse long segment CA stenosis is the most important predictors for MACE.