Pediatric Coronary Artery Revascularization Surgery: Development and Effects on Survival, Cardiac Events and Graft Patency for Children With Kawasaki Disease Coronary Involvements

Abstract

Pediatric coronary artery bypass surgery gained wide acceptance with the introduction of internal thoracic arteries (ITAs) for bypass operations for post Kawasaki disease (KD) lesions. The technique is now established as the standard surgical choice, and its safety even in infancy, graft patency, growth potential, graft longevity and clinical efficacy have been well documented. In this article the author reviews the development of pediatric coronary bypass as the main indication for the treatment of coronary lesions due to KD. I believe that coronary revascularization surgery in pediatric population utilizing uni- or bilateral ITAs is the current gold-standard as the most reliable treatment, although percutaneous coronary intervention with or without a stent has been tried with vague long-term results in children.

A new arena in cardiac surgery: Pediatric coronary artery bypass surgery

“…The wall configuration of the ITA graft was smooth, with no luminal stenosis or dilatation, and it matched well in size with that of the recipient coronary artery at 20 years after the operation. 27 , 33 ) In addition, ITA grafts length grew in proportion to the patient’s body growth 30 , 31 ) (r = 0.845, P < 0.001). In contrast, SVGs had poor response to body growth, was usually dilated with local narrowing, and was sometimes aneurysmal, with prominent irregularities of the wall contour.…”

“…All of these excellent ITA graft qualities in children have been clearly demonstrated in a 30-year follow-up study involving more than 100 children. 27 , 32 , 33 ) Use of the right or left ITA depended on the anatomical location of the target coronary artery.…”

“… 27 , 35 ) A total of 95% of children operated on with at least 1 ITA graft were alive at 30 years postoperatively, while more than 84% could work well and had integrated into society without specific limitations, and female subjects could safely sustain pregnancy and deliver a baby. 27 , 33 )…”

“… 41 – 43 ) In contrast, the SVG became occluded not only early on, within 1 year postoperatively, but also much later postoperatively due to intimal fibroproliferation that eventually resulted in atherosclerosis. 27 , 33 , 35 , 44 )…”

A case report of an acute coronary syndrome in a 10-year-old boy with homozygous familial hypercholesterolaemia

“…Coronary bypass graft surgery is particularly complex for child patients. 5 Furthermore, outcomes in short- and long-term follow-up are well known for Kawasaki patients but there is few data for plaque rupture MI in childhood. ITA bypass graft is the strategy of choice and has better outcomes than autologous saphenous vein graft.…”