Coronary artery bypass grafting for Kawasaki disease
Hong-wei Guo1, Qian Chang, Jian-ping Xu
1Department of Surgery, Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
Insights
Coronary artery bypass grafting (CABG) offers a safe and effective treatment for children with Kawasaki disease (KD) coronary artery disease, improving angina and cardiac function. Long-term outcomes require further monitoring.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Kawasaki disease (KD) is a leading cause of pediatric ischemic heart disease.
- Coronary artery sequelae affect 2-3% of KD patients, with high mortality from myocardial infarction.
- Evaluating surgical interventions for KD coronary artery disease is critical.
Purpose of the Study:
- To assess the efficacy and safety of coronary artery bypass grafting (CABG) in pediatric patients with Kawasaki disease.
- To analyze short-term outcomes and complications of CABG in this specific population.
Main Methods:
- Retrospective review of eight pediatric patients with KD who underwent CABG between 1997 and 2005.
- Details of bypass graft types (LIMA, IMA, GEA, SVG) and combined procedures were recorded.
- Management of cardiopulmonary bypass (CPB) and intra-aortic balloon pump (IABP) support were noted.
Main Results:
- One perioperative death occurred due to low cardiac output syndrome and renal failure.
- The remaining seven patients recovered and were discharged uneventfully.
- Follow-up (mean 27 months) showed improved or resolved angina and maintained New York Heart Association Class I-II cardiac function.
Conclusions:
- Coronary artery bypass grafting (CABG) is a safe and effective surgical option for managing severe coronary artery disease in pediatric patients with Kawasaki disease.
- While short-term results are promising, long-term efficacy and durability of CABG require continued follow-up.
Background:
Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2% - 3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.
Methods:
Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5 +/- 0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.
Results:
One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months), clincal angina disappeared or improved. Cardiac function was in Class I - II (NYHA).
Conclusion:
CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.
