Long-term outcomes following surgical repair of coronary artery fistula in adults

Abstract

Background and aim of the study: Coronary artery fistula (CAF) is a\nrelatively rare cardiac anomaly. We investigated long-term outcomes\nfollowing surgical repair of CAF in adults. Methods: We retrospectively\ninvestigated 13 consecutive patients undergoing surgical repair of CAF\nin our institution between 2008 and 2019 (67.3±10.4 years old, 38%\nmale). CAF types were coronary artery-pulmonary artery fistula (77%),\ncoronary artery-coronary sinus fistula (15%), and both (8%). CAFs\noriginated from the left coronary artery (38%), right coronary artery\n(8%), and bilateral coronary arteries (38%). Pulmonary and systemic\nflow (Qp/Qs) was measured in seven patients (54%), with a mean value of\n1.52. Seven patients underwent surgery for CAFs alone, and others\nsimultaneously underwent surgery for comorbid cardiac diseases. Results:\nAll procedures were conducted under cardiopulmonary bypass. Surgical\nprocedures were direct epicardial ligation of fistula (92%), direct\nclosure of CAF through pulmonary artery incision (38%), direct closure\nof CAF through coronary sinus incision (8%), or patch closure of CAF\nthrough coronary artery incision (8%). Myocardial perfusion\nscintigraphy showed asymptomatic myocardial ischemia in the right\ncoronary area after surgery in one patient. There were no deaths\nperioperatively or during follow-up (mean 66.6 months). There were no\ncoronary or other CAF-related events. Conclusions: Several anatomical\nvariations in CAF were observed which coexist with cardiac disease.\nLong-term outcomes following surgical repair were satisfactory, and the\nconcurrent intervention of CAFs during surgery for comorbid cardiac\ndisease is useful to prevent future complications related CAFs in\nadults.