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Coronary Revascularization in Children at a Mexican Cardiac Center: Thirteen-Year Outcomes
Samuel E Ramírez-Marroquín1, Alejandra Iturriaga-Hernández1, Juan Calderón-Colmenero2
11 Department of Pediatric Cardiac and Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez, Ciudad de México, México.
Insights
Pediatric coronary artery bypass grafting using arterial grafts is safe and effective for children with coronary disease, showing excellent survival rates and no mortality in a recent study.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Research
- Vascular Grafting
Background:
- Pediatric coronary revascularization addresses diverse conditions, including sequelae of severe inflammatory diseases like Kawasaki disease.
- Less common causes also contribute to the need for pediatric coronary artery bypass surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass surgery in pediatric patients.
- To assess outcomes and long-term follow-up of children undergoing coronary revascularization.
Main Methods:
- Retrospective review of ten pediatric patients who underwent coronary artery bypass surgery between 2004 and 2016.
- Surgical procedures involved cardiopulmonary bypass and crystalloid cardioplegic arrest, with arterial grafts utilized for revascularization.
Main Results:
- Ten children (age 2-17 years) were followed up for a median of 2 years (up to 13 years).
- Indications included ischemia symptoms and/or coronary stenosis; diagnoses comprised Kawasaki disease, anomalous origin of the left coronary artery, and iatrogenic lesions.
- No mortality or symptoms were observed during follow-up, with an average of 1.6 distal anastomoses per patient.
Conclusions:
- Coronary revascularization using arterial grafts is a safe and reliable surgical option for pediatric coronary artery disease.
- Excellent survival rates were achieved, though continued follow-up is necessary to monitor long-term outcomes.
Background:
The indications for pediatric coronary revascularization are diverse. There are a large proportion of patients with sequelae of severe inflammatory diseases such as Kawasaki disease, and other less common causes.
Methods:
Retrospective review of ten pediatric patients undergoing coronary artery bypass surgery from January 2004 to December 2016.
Results:
Ten children and adolescents ranging in age from 2 to 17 (median, 6) years at operation were followed up for as long as 13 years with a median follow-up of 2 years. The surgical indications include ischemia symptoms and/or coronary stenosis angiographically documented. Diagnoses include Kawasaki disease, anomalous origin of the left coronary artery from the pulmonary artery, and iatrogenic lesion of the right coronary artery. All the surgical procedures were performed with cardiopulmonary bypass with crystalloid cardioplegic arrest. The number of distal anastomoses was 1.6 per patient, and the left internal thoracic artery was used in one patient, the right internal thoracic artery in four patients, bilateral internal thoracic artery in four patients, and bilateral internal thoracic artery plus left radial artery in one patient, most frequently for right coronary artery revascularization. The patients underwent noninvasive diagnostic study during follow-up to evaluate their coronary status. The ten patients had no symptoms, and there was no mortality.
Conclusions:
Although survival was excellent after pediatric coronary bypass in our center, we need to continue the follow-up. Coronary revascularization by means of arterial grafting is a safe and reliable surgical modality for coronary disease in children.