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[Comparative studies of various conduits for myocardial revascularization with Kawasaki disease]
Y Takeuchi1, Y Okamura, S Torii
1Department of Cardiovascular Surgery, Kanto Teishin Hospital.
Insights
For Kawasaki disease patients needing coronary bypass surgery, arterial grafts like the internal thoracic artery offer superior long-term patency compared to saphenous vein grafts. Arterial grafts are recommended for better surgical outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Vascular Grafting
Background:
- Kawasaki disease frequently leads to coronary artery aneurysms requiring surgical intervention.
- Graft selection is critical for long-term outcomes in pediatric coronary artery bypass surgery.
Purpose of the Study:
- To compare the long-term patency and morphologic characteristics of different arterial and venous grafts used in coronary bypass surgery for Kawasaki disease patients.
Main Methods:
- Retrospective analysis of 44 coronary bypass surgeries in 36 Kawasaki disease patients between 1976 and 1991.
- Evaluation of saphenous vein grafts (SVG), left internal thoracic artery (LITA), right internal thoracic artery (RITA), and gastroepiploic artery (GEA).
- Assessment of graft patency rates and morphologic changes at 1 month and 1-3 years postoperatively.
Main Results:
- Arterial grafts demonstrated 100% patency at 1 month and 94.7% at 1-3 years, with improved length and diameter over time.
- Saphenous vein grafts showed a decline in patency from 90% at 1 month to 52% at 1-3 years.
- Internal thoracic artery grafts exhibited superior flow potential compared to gastroepiploic artery grafts.
Conclusions:
- Internal thoracic artery is the preferred graft material, followed by the gastroepiploic artery for Kawasaki disease patients.
- Saphenous vein grafts have poor long-term results, and exclusive use of arterial grafts is recommended for coronary revascularization.
Abstract:
Between October 1976 and December 1991, 36 patients with Kawasaki disease underwent coronary bypass surgery. Comparisons were made from the postoperative morphologic condition of 4 conduits; saphenous vein graft (SVG n = 27), left internal thoracic artery (LITA n = 22), right internal thoracic artery (RITA n = 5) and gastroepiploic artery (GEA n = 8). The patency rate of arterial grafts was 100% at 1 month after surgery, and kept as high as 94.7% at 1-3 years after surgery. On the other hand, the patency rate of SVG was 90% at 1 month, but decreased to 52% at 1-3 years postoperatively. Arterial grafts sometimes showed string sign at 1 month after surgery, but the length and the diameter increased during 1 year after surgery. The internal thoracic artery showed superior flow potential compared with GEA. Thus, the internal thoracic artery is the first choice and GEA is the second as the graft material with Kawasaki disease. Long-term result of SVG was very poor, so coronary revascularization only by the arterial grafts is recommended.