Related Experiment Video
Updated: Jan 25, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Multiple Coronary Artery Bypass Grafting for Kawasaki Disease-Associated Coronary Artery Disease
Naoki Tadokoro1, Tomoyuki Fujita1, Satsuki Fukushima1
1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Insights
Multiple coronary artery bypass grafting (CABG) using arterial conduits offers a safe and effective long-term strategy for advanced Kawasaki disease (KD)-associated coronary artery disease, demonstrating comparable survival rates to single CABG.
Area of Science:
- Cardiology
- Pediatric Surgery
- Vascular Surgery
Background:
- Kawasaki disease (KD) can lead to advanced coronary artery disease (CAD).
- Coronary artery bypass grafting (CABG) is the preferred treatment for advanced KD-associated CAD.
- Optimal graft design for CABG in KD sequelae remains undetermined.
Purpose of the Study:
- To investigate the optimal revascularization strategy for coronary artery disease in patients with Kawasaki disease sequelae.
- To compare the long-term outcomes of single versus multiple CABG in this patient population.
Main Methods:
- A retrospective review of 102 CABG surgeries in 92 patients over 36 years.
- Patients were categorized into single (n=53) or multiple (n=49) CABG groups.
- Analysis included actuarial survival, freedom from cardiac events, and graft patency.
Main Results:
- Actuarial survival at 30 years was 93% for single CABG and 91% for multiple CABG (P=.71).
- Freedom from cardiac events at 25 years was 45.2% for single and 68.5% for multiple CABG (P=.228).
- Internal thoracic artery graft patency was high (81-85%), and radial artery grafts showed superior patency over saphenous vein grafts at 10 years (91% vs 46%, P=.013).
Conclusions:
- Multiple CABG using arterial conduits is a feasible and safe long-term therapeutic option for advanced KD-associated CAD.
- Arterial conduits, particularly the internal thoracic artery and radial artery, demonstrate favorable long-term patency.
- The findings support multiple CABG as an effective strategy for managing complex coronary artery disease in Kawasaki disease survivors.
Background:
Although coronary artery bypass grafting (CABG) is the preferred choice for advanced Kawasaki disease (KD)-associated coronary artery disease, graft design such as number of grafts or type of conduits has not been fully established. We reviewed a series of patients who underwent single or multiple CABG for coronary artery disease of KD sequelae to investigate the optimum revascularization strategy.
Methods:
We enrolled a consecutive series of 102 CABG surgeries in 92 patients during the last 36 years. Mean patient age at CABG was 14.9 ± 10.4 years. Internal thoracic artery, radial artery, and gastroepiploic artery were used in 100 (98%), 18 (15%), and 4 (4%) cases, respectively. Patients were divided into 2 groups by single (n = 53) or multiple (n = 49) CABG.
Results:
Actuarial survival was 93% in single CABG and 91% in multiple CABG at 30 years (P = .71). There was no in-hospital mortality, but 6 deaths occurred long term, with no significant difference between the groups. Freedom from cardiac events was 45.2% in single CABG and 68.5% in multiple CABG at 25 years (P = .228), and reintervention to the left anterior descending (LAD) artery territory was the most common event. Graft patency of the internal thoracic artery-LAD artery graft was 81% in single CABG and 85% in multiple CABG at 25 years. Patency of the radial artery in the non-LAD artery territories was significantly greater than that of the saphenous vein graft at 10 years (91% vs 46%, P = .013).
Conclusions:
Multiple CABG using arterial conduits is feasible, safe, and therapeutically effective long term for patients with advanced KD-associated coronary artery disease.
More Related Videos
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:30Peripheral Artery Disease I: Introduction