Impact of prior congenital heart surgery on coronary artery bypass grafting outcomes in adults with congenital heart disease

Abstract Background The long-term impact of prior congenital heart disease (CHD) surgeries on adult cardiac surgery outcomes remains underexplored. Our study evaluates the influence of prior congenital heart interventions on postoperative outcomes in adult patients undergoing cardiac surgery. Method We conducted a retrospective cohort study using the TriNetX database, analyzing adults with repaired CHD who later underwent coronary artery bypass grafting (CABG). This cohort was then compared to age-, gender-, race-, ethnicity-, comorbidity-, medication-, and CHD diagnosis-matched controls of patients with unrepaired CHD requiring CABG in adulthood. After propensity score matching, each group included 1425 individuals. Results After matching, there were no statistically significant differences in baseline characteristics. Patients with a history of prior CHD surgical repair had significantly lower odds of 30-day all-cause mortality (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.21–0.52, p < 0.01). However, this group also showed increased odds of hospital readmission within 30 days (OR 1.33, 95% CI 1.14–1.54, p < 0.01). Secondary outcomes showed higher incidence of acute kidney injury (AKI) (OR 1.42, p < 0.01), pleural effusion (OR 1.33, p < 0.01), and cardiac arrhythmias (OR 1.52, p < 0.01) in the CHD-repaired group. No significant differences were observed for acute myocardial infarction (MI), stroke, transient ischemic attack (TIA), or need for reoperation. Conclusion These results suggest that patients with prior CHD repairs can successfully undergo coronary revascularization later in life despite having a distinct postoperative risk profile. However, it may also predispose patients with repaired CHD to higher rates of certain postoperative complications, including arrhythmias, pleural effusion, and AKI.