Abstract 21278: Time to Diagnosis of Acute Coronary Obstruction Following Surgical Repair of Congenital Heart Disease is Associated With Improved Transplant-Listing Free Survival

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Objectives: Acute coronary artery obstruction (CAO) following surgical repair of congenital heart disease (CHD) is rare but carries a high burden of morbidity and mortality. Prior reports describe the complication in individual populations of CHD, though few have looked at factors associated with outcomes. We hypothesize that increased time from a clinically significant post-operative sentinel event suggestive of coronary ischemia to diagnosis of CAO is associated with worse clinical outcomes.

Methods: Single center retrospective review of patients diagnosed with acute post-operative CAO by coronary angiography following surgical repair of CHD between January 2000 and June 2016. Sentinel events were identified and timestamped. Characteristics compared by Fisher’s Exact and Wilcoxon Rank-Sum test. Exact logistic regression used for primary analysis.

Results: A total of 34 patients were identified with acute post-operative CAO, n=32 (94%) had an identifiable sentinel event: n=15 (47%) cardiac arrest, n=12 (38%) persistent ventricular dysfunction, n=5 (16%) malignant arrhythmia. Longer sentinel event to angiography time was associated with composite outcome of death or heart transplant listing (OR 1.08 for each additional hour (1.02-1.17), p = 0.03). This association remained when adjusting for significant covariates of HLHS diagnosis (OR 1.06 (1.01-1.15) p=0.01) and surgical coronary manipulation (OR 1.07 (1.01-1.16), p=0.003). Ultimately in the series, n=27 (79%) required ECMO, n=14 (41%) died, and n=9 (27%) were listed for heart transplant.

Conclusions: In the largest cohort described to date, time from a significant post-operative event to diagnosis of CAO by angiography was associated with death or heart transplant listing. Given the high burden of ECMO and death in this population, clinicians should maintain a high index of suspicion for CAO in patients who do not follow typical post-operative trajectory and consider early advanced diagnostics.

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