Acute coronary artery obstruction following surgical repair of congenital heart disease

J Thorac Cardiovasc Surg. 2020 May;159(5):1957-1965.e1. doi: 10.1016/j.jtcvs.2019.09.073. Epub 2019 Oct 3.


Objectives: Acute coronary artery obstruction is a rare complication of congenital heart disease surgery but imposes a high burden of morbidity and mortality. Previous case series have described episodes in specific congenital heart lesions or surgical repairs but have not examined the complication in all-comers to congenital heart surgery. We hypothesize that shorter time from a clinically recognized postoperative sentinel event suggestive of coronary ischemia to diagnosis of coronary obstruction is associated with improved clinical outcomes.

Methods: This was a single-center, retrospective review of patients diagnosed with acute coronary artery obstruction by angiography following surgical repair of congenital heart disease between January 2000 and June 2016.

Results: In total, 34 patients were identified. The most common procedures associated with coronary artery obstruction were the Norwood procedure, arterial switch operation, and aortic valve repair/replacement. In total, 79% required mechanical circulatory support, 41% died, and 27% were listed for heart transplant. Patients who died or were listed for heart transplant had longer median sentinel-event-to-cardiac-catheterization time (28 [6-168] hours vs 10 [3-56] hours, P = .001), and longer median sentinel-event-to-intervention time (32 [11-350] hours vs 13 [5-59] hours, P = .003). Patients with hypoplastic left heart syndrome were at greater risk of death or transplant listing (odds ratio, 9.23, P = .03).

Conclusions: Time from clinically relevant postoperative sentinel event to diagnosis of coronary artery obstruction by angiography was associated with transplant-listing-free survival. Clinicians should maintain a high index of suspicion for coronary obstruction and consider early catheterization and coronary angiography for patients in whom post-operative coronary compromise is suspected.

Keywords: congenital heart disease surgery; coronary interventions; coronary obstruction; coronary thrombosis; post-operative complications.

MeSH terms

  • Adolescent
  • Adult
  • Cardiac Surgical Procedures / adverse effects*
  • Child
  • Child, Preschool
  • Coronary Occlusion* / epidemiology
  • Coronary Occlusion* / mortality
  • Coronary Occlusion* / surgery
  • Coronary Vessels / physiopathology
  • Coronary Vessels / surgery
  • Female
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / mortality
  • Postoperative Complications* / surgery
  • Retrospective Studies
  • Young Adult