CABG With Internal Thoracic Artery in Children With Congenital Heart Defects: A Good Option When It Is the Only One
Christian Kreutzer1, Gustavo Bastianelli2, Benjamin Chiostri1
1Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina.
Insights
Coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) grafts is a valuable option for children with complex congenital heart defects. All patients in this study showed successful graft patency and remained asymptomatic, highlighting the long-term viability of arterial grafts in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Vascular Grafting
Background:
- Coronary artery complications are a known risk during and after congenital heart defect repairs.
- Complex coronary anatomy in pediatric patients often necessitates specialized surgical interventions beyond standard repairs.
Observation:
- This study retrospectively reviewed four pediatric cases undergoing coronary artery bypass grafting (CABG) with internal thoracic artery (ITA) grafts between March 2016 and March 2020.
- Patients presented with diverse congenital anomalies including anomalous coronary artery origin, post-arterial switch hypoplasia, and coronary stenosis after previous procedures.
- Surgical interventions involved various ITA graft configurations to address specific coronary artery issues, often combined with other cardiac repair procedures.
Findings:
- All four patients were asymptomatic at the last follow-up, demonstrating successful management of coronary complications.
- Ventricular function remained normal in all patients post-operatively.
- All internal thoracic artery grafts were patent, indicating excellent long-term graft viability in this pediatric cohort.
Implications:
- Coronary artery bypass grafting (CABG) with arterial grafts like the internal thoracic artery (ITA) is a crucial alternative for complex pediatric coronary anomalies.
- The long-term patency observed in this study supports the mandatory use of arterial grafts for pediatric patients requiring grafts with a >50-year lifespan.
- This approach offers a viable solution for improving long-term outcomes in children with challenging congenital heart disease and associated coronary issues.
Objective:
Coronary complications may present during or after repair of congenital heart defects. We report coronary artery bypass grafting (CABG) by internal thoracic artery (ITA) grafts to either coronary artery in children with congenital anomalies.
Methods:
Four cases who underwent CABG with ITA grafts from March 2016 to March 2020 were retrospectively reviewed.
Results:
At the time of operation, patient's ages and weight were 7 and 20 months old and 14 and 15 years old and 6.5, 10, 40, and 45 kg, respectively. Diagnosis were anomalous origin of the left coronary artery from the pulmonary artery with leftward lateral ostial origin (n = 1), neopulmonary annulus hypoplasia post arterial switch with contiguous right coronary artery (RCA) arising from the left facing sinus (n = 1), RCA stenosis after the Ross procedure (n = 1), and right coronary ostial obstruction after aortic valve replacement in truncus arteriosus (n = 1). Procedures included left ITA to left coronary ostium (n = 1), right ventricular outflow tract (RVOT) enlargement with pulmonary valve replacement with left ITA to RCA (n = 1), RVOT enlargement with pulmonary valve replacement with right ITA to RCA (n = 1), and aortic valve re-replacement, pulmonary valve replacement, and right ITA to RCA (n = 1). At last follow-up, all four patients were asymptomatic, with normal ventricular function, and all grafts were patent.
Conclusions:
The use of CABG in children is valuable alternative when dealing with complex coronary anatomy not suitable for classic repairs. In children, graft patency is required to be longer than 50 years; therefore, use of arterial grafts seems mandatory.
