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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary artery bypass grafting in children
Ahmet Arnaz1, Tayyar Sarioglu1, Yusuf Yalcinbas2
1Department of Cardiovascular Surgery, School of Medicine, Acibadem University, Istanbul, Turkey.
Insights
Coronary artery bypass grafting (CABG) in children, particularly using internal mammary arteries (IMAs), shows promising results. This pediatric CABG study highlights IMA graft choice for long-term patency and growth potential.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Congenital Heart Disease
Background:
- Clinical experience with coronary artery bypass grafting (CABG) in pediatric patients is presented.
- Focus on outcomes in children with complex congenital cardiac malformations.
Purpose of the Study:
- To evaluate the clinical outcomes of pediatric coronary artery bypass grafting (CABG).
- To identify optimal graft choices for long-term success in children undergoing CABG.
Main Methods:
- Retrospective analysis of ten children undergoing CABG between 1995 and 2017.
- Data collected included cardiac malformations, prior surgeries, age, sex, coronary complications, ischemic events, and ventricular function.
Main Results:
- Eight internal mammary arteries (IMAs) and two saphenous veins were used. Indications included post-arterial switch, Ross procedure complications, and tetralogy of Fallot repair.
- Six grafts were rescue procedures; three patients died during hospitalization. Mean follow-up was 6.8 years.
- Coronary angiography showed all four evaluated anastomoses were patent. Echocardiography confirmed normal myocardial function post-CABG.
Conclusions:
- Internal mammary artery (IMA) is suggested as the preferred graft in pediatric CABG.
- IMA offers superior growth potential and long-term patency compared to other grafts in children.
Background:
We present our clinical experience with coronary artery bypass grafting (CABG) in children.
Methods:
Ten children who underwent CABG between July 1995 and August 2017 were retrospectively analyzed. Data including congenital cardiac malformations, previous surgical procedures, age and sex, type of coronary complications, ischemic events preceding surgery, and ventricular function before and after CABG were recorded.
Results:
The study population consisted of five males and five females with a median age of 2.5 years (range, 88 days to 15 years). Eight internal mammary arteries (IMAs) and two saphenous veins were used for grafting. Indications for bypass grafting were coronary artery (CA) complications related to the post-arterial switch operation in six, CA complications during the Ross procedure in two, and an iatrogenic CA injury during complete repair of tetralogy of Fallot with abnormal CA, crossing the right ventricular outflow tract in two patients. Six of the grafts were performed as rescue procedures. Three patients died during hospitalization. The mean follow-up time was 6.8 years (range, 3 months to 18 years). Anastomoses were evaluated by coronary angiography in four patients, and were all patent. Echocardiography revealed normal myocardial function in all patients.
Conclusion:
Our study suggests that the IMA should be the graft of choice in children due to its growth potential and long-term patency.
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