Outcome of coronary artery bypass grafting performed in young children
Antoine Legendre1, Alain Chantepie, Emre Belli
1Pediatric Cardiology Unit, Hopital Clocheville, CHRU et Université François Rabelais de Tours, Tours, France. antoine.legendre@nck.aphp.fr
Insights
Coronary artery bypass grafting using arterial grafts shows good patency in children under 3 years old. This procedure is a viable option for pediatric coronary revascularization but requires careful follow-up.
Area of Science:
- Pediatric Cardiac Surgery
- Vascular Surgery
- Congenital Heart Disease
Background:
- Arterial grafts offer high long-term patency for pediatric coronary artery bypass grafting.
- Patency rates in children under 3 years of age remain less certain.
- This study addresses outcomes in this specific young pediatric population.
Purpose of the Study:
- To evaluate the long-term patency of arterial grafts in coronary artery bypass grafting (CABG) for children under 3 years of age.
- To assess the feasibility and outcomes of CABG in this young pediatric cohort.
- To determine the suitability of CABG as a revascularization strategy in infants and toddlers.
Main Methods:
- A retrospective review of 18 children under 3 years old (median age 4 months) who underwent 20 CABG operations using arterial grafts between July 1988 and July 2007.
- Indications included coronary artery complications post-arterial switch operation, congenital coronary anomalies, and Kawasaki disease.
- Graft patency was assessed postoperatively with a mean follow-up of 55 months.
Main Results:
- Of 19 assessed bypass grafts, one was occluded and two required percutaneous intervention.
- Two sudden deaths occurred postoperatively (at 3.5 and 4.6 months), one with an occluded graft and one with a patent graft and hypertrophic cardiomyopathy.
- A generally good patency rate was observed in this cohort.
Conclusions:
- Coronary artery bypass grafting with arterial grafts is a potential alternative for coronary revascularization in very young children.
- Despite a favorable patency rate in this series, the procedure presents technical challenges.
- Careful long-term follow-up is essential for pediatric patients undergoing CABG.
Objectives:
The long-term patency rate of coronary artery bypass grafting for which arterial grafts are used is known to be high in the pediatric population. However, this issue remains uncertain in children under 3 years of age. Here, we report the outcome in this specific population.
Methods:
From July 1988 to July 2007, 18 children less than 3 years of age (age at operation, 0.1-35 months; median, 4 months) underwent 20 coronary artery bypass graft operations using an arterial graft. Indications for bypass grafting were coronary artery complications related to the arterial switch operation for transposition of the great arteries in 12 patients (coronary obstruction in 8 patients, peroperative coronary anomalies precluding coronary transfer in 4 patients), congenital anomalies of the coronary arteries in 4 patients, and Kawasaki disease in 2 patients.
Results:
After a mean follow-up of 55 months (range, 1-176 months; median, 41 months), patency of 19 bypass grafts was assessed. One was occluded and 2 have necessitated a percutaneous procedure. Two patients died suddenly (1 with an occluded graft and 1 with a patent graft and hypertrophic myocardiopathy) 3.5 and 4.6 months, respectively, after bypass grafting.
Conclusions:
Coronary artery bypass grafting should be considered as a possible alternative for coronary revascularization in young children. Although our series shows quite a good patency rate, this procedure remains a technical challenge and requires careful follow-up.
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