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Survival And Re-intervention Following Elective Versus Rescue Coronary Ostioplasty For Congenital Heart Disease
Junko Kobayashi1, Devin Chetan2, Jaymie Varenbut3, Shuhua Luo4, Christoph Haller1, Kyle Runeckles5, Chun-Po S. Fan5, Glen S. Van Arsdell6, David J. Barron1, Osami Honjo1.
1Division of Cardiovascular Surgery, The hospital for Sick Children, Department of Surgery, University of Toronto, TORONTO, ON, Canada, 2Division of Cardiology, The hospital for Sick Children, Department of Paediatrics, University of Toronto, TORONTO, ON, Canada, 3Division of Cardiovascular Surgery, The hospital for Sick Children, TORONTO, ON, Canada, 4Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China, 5Data Analysis Centre, the Hospital for Sick Children, TORONTO, ON, Canada, 6Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Department of Surgery, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.

Objective: Surgical intervention to the stenotic coronary artery ostium poses significant technical challenges and risks of myocardial ischemia. We sought to analyze the outcomes of coronary ostioplasty with special interest on the mode (elective vs. rescue) of the intervention. Methods: 63 children with underlying congenital heart disease who required coronary ostioplasty from 2000 to 2019 were included. Kaplan-Meier, competing risk, and Cox regression models were utilized. Results: Diagnoses were transposition of the great arteries (36.5%), supravalvular aortic stenosis (25.4%), and anomalous aortic origin of the coronary artery (19.0%). Ostioplasty was achieved by patch augmentation (n=44), unroofing (n=15), and ridge resection (n=4), which was done on left (73.0%), right (12.7%), or both coronary arteries (14.3%). 5-year overall survival was 81.6%, and the 5-year proportion with coronary re-intervention was 21.3%. Pre-operative ECMO (p=0.006) and longer cardiopulmonary bypass time (p<0.001) as predictors for death, and rescue ostioplasty (p=0.013) and pre-operative ECMO (p=0.011) as predictors for coronary re-intervention were identified. The rescue group (n=22, 35%) had significantly worse survival (5-year: 49.6% vs. 100%, p<0.001 Figure1A), and a higher 5-year proportion with coronary re-intervention (33.3% vs. 14.1%, p=0.023, Figure1B). Elective cases showed significantly better biventricular function in the latest echocardiography (p<0.01). Conclusions: Rescue ostioplasty is associated with low survival and high re-intervention with suboptimal ventricular function. Data highlights the importance of preoperative thorough investigation for potential coronary ostial stenosis.


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