Outcomes of Surgical and Transcatheter Closure of Congenital Coronary Artery Fistulas: Results from a National Audit Database

Special Article - Cardiac Surgery

Austin J Surg. 2016; 3(2): 1084.

Outcomes of Surgical and Transcatheter Closure of Congenital Coronary Artery Fistulas: Results from a National Audit Database

Fudulu DP*, Dorbantu DM, Caputo M and Stoica SC

Department of Congenital Heart Surgery, University Hospitals Bristol NHS Foundation Trust, UK

*Corresponding author: Fudulu DP, Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol, UK

Received: May 26, 2016; Accepted: July 11, 2016; Published: July 13, 2016

Abstract

Congenital coronary arterial venous fistulae are very rare anomalies. We analyzed data from a national procedure database and identified 79 (0.09%) catheter and surgical closures of coronary fistulae out of total of 88061 procedures performed over a 12 year period. Thirty four patients (43%) underwent surgical closure while 45 (57%) patients had catheter closure. Sixty six patients (83.5%) had complete follow-up. There were no early deaths, and mortality at 10 years was 4.8%. Freedom from fistula reintervention was 91.2% for the trans catheter group vs. 100% in the surgical group (p=0.11). We found no differences in outcomes between patients with isolated fistulas and those associated with other congenital defects. Surgical or catheter treatment of coronary fistulae is attainable with no early mortality and good medium term outcomes. However, reintervention rates appear to be higher in trans catheter patients.

Keywords: Coronary arteries abnormalities; Arteriovenous fistulas; Cardiac surgical procedures; Catheter ablation

Abbreviations

CAF: Congenital Coronary Artery Fistulas; NICOR: National Institute for Cardiovascular Outcomes Research; SD: Standard Deviation

Introduction

Congenital Coronary Artery Fistulas (CAF) is very rare termination anomalies. The reported incidence in patients undergoing cardiac catheterization ranges from 0.13-0.6% [1]. Without treatment, patients may develop heart failure secondary to a left to right shunt, myocardial ischemiaby “coronary steal”, bacterial endocarditis due to turbulent flow and, rarely, aneurysmal rupture [2]. Current literature results following CAF repair originate from small series and reviews [1-5]. Surgery offers excellent outcomes [1,4,5], however transcatheter closure is emerging as a less invasive alternative. The present study reports 79 consecutive arteriovenous CAF patients treated with transcatheter or surgical closure with an emphasis on reinterventions and survival outcomes.

Material and Methods

The dataset

The National Institute for Cardiovascular Outcomes Research (NICOR) collects data on cardiac procedures from all the UK heart units with the aim of reporting outcomes following surgical and transcatheter procedures (available at https://nicor4.nicor.org.uk/). We identified 79 patients who underwent a coronary fistula procedure between April 2000 and March 2013 from 20 centers.

Statistical analysis

Frequencies are given as absolute numbers and percentages, continuous values as mean (SD) or median (inter-quartile range).

Comparisons of proportions were done with the Fisher Exact test. Estimates of long term survival and freedom from reintervention were done with the Kaplan Meier method using mortality (all cause) and reoperations (coronary) as failure events and comparisons of survival and reintervention between groups were evaluated with the log-rank test.

Results

Table 1 shows the demographic, clinical, procedural and followup data of the surgical and catheter groups. Out of a total of 88061 patients undergoing catheter and surgical procedures, coronary fistulas repairs were performed in only 0.09% of cases. Sixty six patients (83.5%) had complete follow-up. Figure 1 illustrates the freedom from coronary reintervention at 10 years, by procedure type. There were no early deaths, and mortality at 10 years was 4.8%. No coronary reinterventions were observed in the surgical group, while a total of 3 patients from the transcatheter group had either a repeat transluminal occlusion (n=2) or a surgical ligation. Out of these, one patient required three occlusion procedures in three years. The freedom from fistula reintervention was 91.2% for the transcatheter group vs. 100% in the surgical group (p=0.11). No differences in outcomes were found between patients with isolated fistulas and those with associated abnormalities.

Citation: Fudulu DP, Dorbantu DM, Caputo M and Stoica SC. Outcomes of Surgical and Transcatheter Closure of Congenital Coronary Artery Fistulas: Results from a National Audit Database. Austin J Surg. 2016; 3(2): 1084.