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Jeong DS, Han W, Lee YT, Kim WS, Song J, Kang IS, Park PW. Coronary Artery Bypass Grafting with Arterial Grafts in Patients with Kawasaki Disease Affecting the Coronary Artery: a Korean Single-Center Study. J Korean Med Sci 2018; 33:e267. [PMID: 30310367 PMCID: PMC6179982 DOI: 10.3346/jkms.2018.33.e267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aimed to review the long-term clinical outcomes and graft patency of coronary artery bypass grafting (CABG) using arterial grafts in patients with Kawasaki disease (KD) affecting the coronary artery. METHODS Twenty patients with KD who underwent CABG from January 2002 to June 2014 were enrolled. There were 4 male (20%) and 16 female (80%) patients with ages at operation ranging from 2 to 42 years (median, 17.5 years). Our routine operative strategy was off-pump CABG with arterial grafts. The mean follow-up duration was 59.5 ± 48.5 months (range, 1-159 months). Coronary angiogram or computed tomography angiogram was used to evaluate graft patency in 16 patients (80%). RESULTS All patients survived CABG without late mortality. Left internal thoracic arteries were used in 19 patients, while right internal thoracic arteries were used in 10 patients. Right gastroepiploic arteries were used in 3 patients, and a saphenous vein graft (SVG) was used in 1 patient. Among the 20 patients, 2 patients underwent coronary reintervention with balloon angioplasty because of graft failure. Two patients underwent coronary reintervention because of new obstructive lesions that were not significant at the time of the initial operation. Patency rates at 5 and 10 years were 94% and 87%, respectively. The rate of freedom from coronary reintervention at 10 years was 82%. CONCLUSION Off-pump CABG with mainly arterial graft revascularization may be considered a good surgical option for coronary lesions caused by KD.
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Affiliation(s)
- Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woosik Han
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Thammineni K, Vinocur JM, Harvey B, Menk JS, Kelleman MS, Korakiti AM, Thomas AS, Moller JH, St Louis JD, Kochilas LK. Outcomes after surgical coronary artery revascularisation in children with congenital heart disease. Heart 2018; 104:1417-1423. [PMID: 29472291 PMCID: PMC6092219 DOI: 10.1136/heartjnl-2017-312652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Surgical coronary revascularisation in children with congenital heart disease (CHD) is a rare event for which limited information is available. In this study, we review the indications and outcomes of surgical coronary revascularisation from the Pediatric Cardiac Care Consortium, a large US-based multicentre registry of interventions for CHD. METHODS This is a retrospective cohort study of children (<18 years old) with CHD who underwent surgical coronary revascularisation between 1982 and 2011. In-hospital mortality and graft patency data were obtained from the registry. Long-term transplant-free survival through 2014 was achieved for patients with adequate identifiers via linkage with the US National Death Index and the Organ Procurement and Transplantation Network. RESULTS Coronary revascularisation was accomplished by bypass grafting (n=72, median age 6.8 years, range 3 days-17.4 years) or other operations (n=65, median age 2.6 years, range 5 days-16.7 years) in 137 patients. Most revascularisations were related to the aortic root (61.3%) or coronary anomalies (27.7%), but 10.9% of them were unrelated to either of them. Twenty in-hospital deaths occurred, 70% of them after urgent 'rescue' revascularisation in association with another operation. Long-term outcomes were available by external linkage for 54 patients surviving to hospital discharge (median follow-up time 15.0 years, max follow-up 29.8 years) with a 15-year transplant-free survival of 91% (95% CI 83% to 99%). CONCLUSIONS Surgical coronary revascularisation can be performed in children with CHD with acceptable immediate and long-term survival. Outcomes are dependent on indication, with the highest mortality in rescue procedures.
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Affiliation(s)
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian Harvey
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeremiah S Menk
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Anna-Maria Korakiti
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Amanda S Thomas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - James H Moller
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Kitamura S. Pediatric Coronary Artery Bypass Surgery for Congenital Heart Disease. Ann Thorac Surg 2018; 106:1570-1577. [PMID: 29883655 DOI: 10.1016/j.athoracsur.2018.04.085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/03/2018] [Accepted: 04/25/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Pediatric coronary artery bypass surgery (PCABS) for congenital heart disease has become increasingly important in infants and children undergoing modern cardiac surgical procedures, because of its life-saving potential in unsuccessful coronary transfer operation. This review summarizes the current surgical role of PCABS for treating congenital heart diseases. METHODS Databases, mainly PubMed, were searched for relevant publications about coronary bypass operation in the pediatric population, from 1970 (commencement) to March 2018. RESULTS The five main indications were (1) anomalous origin of the left coronary artery from the pulmonary artery, (2) left main coronary trunk atresia, (3) acute and late coronary events in the arterial switch operation for transposition of the great arteries, (4) the Ross operation for congenital aortic stenosis complicated by destructive infective endocarditis, and (5) inadvertent coronary artery injury during heart operation. Direct coronary reimplantation (coronary transfer) in most and surgical angioplastic procedures in selected patients were the first choice; however, PCABS with internal thoracic artery (ITA) grafts can be lifesaving in emergency or severe myocardial hypoperfusion conditions. Because the patency of saphenous vein grafts is poorer than that of ITA grafts, their use should be avoided in growing children. The procedure can be performed safely in neonates, infants, and small children, using high-power magnifying glasses or a surgical microscope. CONCLUSIONS Long-term results of survival and ITA graft function are excellent in growing children and adults. Congenital heart surgeons should be trained in quick graft takedown and in coping with emergency and late devastating complications in coronary transfer operation.
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Arnaz A, Sarioglu T, Yalcinbas Y, Erek E, Turkoz R, Oktay A, Saygili A, Altun D, Sarioglu A. Coronary artery bypass grafting in children. J Card Surg 2018; 33:29-34. [DOI: 10.1111/jocs.13510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmet Arnaz
- Department of Cardiovascular Surgery; School of Medicine; Acibadem University; Istanbul Turkey
| | - Tayyar Sarioglu
- Department of Cardiovascular Surgery; School of Medicine; Acibadem University; Istanbul Turkey
| | - Yusuf Yalcinbas
- Department of Cardiovascular Surgery; Acibadem Bakirkoy Hospital; Istanbul Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery; School of Medicine; Acibadem University; Istanbul Turkey
| | - Riza Turkoz
- Department of Cardiovascular Surgery; Acibadem Bakirkoy Hospital; Istanbul Turkey
| | - Ayla Oktay
- Department of Pediatric Cardiology; Acibadem Bakirkoy Hospital; Istanbul Turkey
| | - Arda Saygili
- Department of Pediatric Cardiology; School of Medicine; Acibadem University; Istanbul Turkey
| | - Dilek Altun
- Department of Anesthiology and Reanimation; Acibadem Bakirkoy Hospital; Istanbul Turkey
| | - Ayse Sarioglu
- Department of Pediatric Cardiology; Acibadem Bakirkoy Hospital; Istanbul Turkey
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Coronary Artery Involvement of Williams Syndrome in Infants and Surgical Revascularization Strategy. Ann Thorac Surg 2015; 101:359-61. [PMID: 26694280 DOI: 10.1016/j.athoracsur.2015.03.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 01/24/2015] [Accepted: 03/18/2015] [Indexed: 11/22/2022]
Abstract
Williams syndrome (WS) is a genetic disorder due to deficiency of elastin gene expression. It is characterized by typical somatic abnormalities and a wide range of cardiovascular malformations. Coronary artery involvement is a frequent finding of the syndrome, particularly in those patients with severe supravalvular aortic stenosis. We present the case of an 11-month-old infant affected by WS who developed severe coronary artery disease 2 months after the surgical repair of supravalvular aortic stenosis. The clinical picture and successful surgical revascularization strategy is also described.
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Dhiware R, Ahmad T, Kumar V, Shivanna DN. Coronary re-vascularisation after arterial switch operation—a case report. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-013-0241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Swartz MF, Schiralli MP, Alfieris GM. Neonatal coronary revascularization: six-year follow-up period. Pediatr Cardiol 2010; 31:1118. [PMID: 20737267 DOI: 10.1007/s00246-010-9779-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 08/05/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Michael F Swartz
- Department of Surgery, University Rochester, Strong Memorial Hospital, Rochester, NY 14582, USA.
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Viola N, Alghamdi AA, Al-Radi OO, Coles JG, Van Arsdell GS, Caldarone CA. Midterm outcomes of myocardial revascularization in children. J Thorac Cardiovasc Surg 2010; 139:333-8. [DOI: 10.1016/j.jtcvs.2009.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/14/2007] [Accepted: 09/06/2007] [Indexed: 10/20/2022]
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Legendre A, Chantepie A, Belli E, Vouhé PR, Neville P, Dulac Y, Vaksmann G, Bonnet D, Serraf A. Outcome of coronary artery bypass grafting performed in young children. J Thorac Cardiovasc Surg 2009; 139:349-53. [PMID: 19775706 DOI: 10.1016/j.jtcvs.2009.07.061] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 06/02/2009] [Accepted: 07/23/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The long-term patency rate of coronary artery bypass grafting for which arterial grafts are used is known to be high in the pediatric population. However, this issue remains uncertain in children under 3 years of age. Here, we report the outcome in this specific population. METHODS From July 1988 to July 2007, 18 children less than 3 years of age (age at operation, 0.1-35 months; median, 4 months) underwent 20 coronary artery bypass graft operations using an arterial graft. Indications for bypass grafting were coronary artery complications related to the arterial switch operation for transposition of the great arteries in 12 patients (coronary obstruction in 8 patients, peroperative coronary anomalies precluding coronary transfer in 4 patients), congenital anomalies of the coronary arteries in 4 patients, and Kawasaki disease in 2 patients. RESULTS After a mean follow-up of 55 months (range, 1-176 months; median, 41 months), patency of 19 bypass grafts was assessed. One was occluded and 2 have necessitated a percutaneous procedure. Two patients died suddenly (1 with an occluded graft and 1 with a patent graft and hypertrophic myocardiopathy) 3.5 and 4.6 months, respectively, after bypass grafting. CONCLUSIONS Coronary artery bypass grafting should be considered as a possible alternative for coronary revascularization in young children. Although our series shows quite a good patency rate, this procedure remains a technical challenge and requires careful follow-up.
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Affiliation(s)
- Antoine Legendre
- Pediatric Cardiology Unit, Hopital Clocheville, CHRU et Université François Rabelais de Tours, Tours, France.
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Sung SC, Chang YH, Lee HD, Kim S, Woo JS, Lee YS. Arterial Switch Operation for Transposition of the Great Arteries With Coronary Arteries From a Single Aortic Sinus. Ann Thorac Surg 2005; 80:636-41. [PMID: 16039219 DOI: 10.1016/j.athoracsur.2005.02.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 02/01/2005] [Accepted: 02/09/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND The reimplantation of the coronary arteries from a single aortic sinus (single sinus coronary artery) in an arterial switch operation remains a technically challenging procedure. The technique of coronary transfer in this situation should be individualized depending on coronary ostial anatomy. We reviewed our techniques of coronary reimplantation with early and midterm results. METHODS Among 103 patients who underwent arterial switch operations from March 1994 to June 2004, 16 (15.5%) had single sinus coronary artery (median age, 9 days; mean body weight, 3.5 kg). Fourteen patients (14/16, 87.5%) had coronary arteries from right facing sinus (sinus 2). Of these 14 patients, 11 had separate ostia including intramural course of the left coronary artery (n = 9) and 3 had single ostium. Two patients (2/16, 12.5%) had coronary arteries from left facing sinus (sinus 1) with single ostium. Aortic arch obstruction was associated in 5 patients. RESULTS All 5 single sinus coronary arteries with single ostium were reimplanted with the trap-door technique. Of the 11 patients with separate ostia, 8 underwent coronary transfer with the aortocoronary flap technique and 3 with the double-button technique. Two of the 3 patients who underwent the double-button technique required left coronary artery bypass using left subclavian artery free graft as the salvaging procedure. There was one early death (1/16, 6.3%), which occurred during our earlier experience, in a patient who had arch anomaly and intramural left coronary artery. There was no late death. All but one patient had good ventricular function. CONCLUSIONS All single sinus coronary artery with single ostium can be transferred with the trap-door technique with excellent results. The aortocoronary flap technique in those with separate ostia with or without intramural left coronary artery may be a good option. However, reimplantation of the intramural left coronary artery using separate coronary buttons should be performed with great care.
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Affiliation(s)
- Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
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Walther T, Dähnert I, Kiefer H, Falk V, Kostelka M, Mohr FW. Beating Heart Off-Pump Myocardial Revascularization in an Infant. Ann Thorac Surg 2005; 79:2151-3. [PMID: 15919335 DOI: 10.1016/j.athoracsur.2003.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2003] [Indexed: 12/01/2022]
Abstract
A 6-week-old patient weighing 4 kg was admitted for surgical correction of anomalous left coronary artery from the pulmonary artery. Reimplantation of the coronary artery with cardiopulmonary bypass was impossible because the patient also had hereditary spherocytosis, which put him at risk for hemolytic anemia. Thus, closure of the left main stem and left internal mammary artery-left anterior descending coronary artery bypass grafting were performed successfully with the heart beating.
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Affiliation(s)
- Thomas Walther
- Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Leipzig, Germany.
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Abstract
Internal thoracic artery grafting in arterial switch operations for transposition of great arteries has been reported for salvage of myocardial ischemia after initial coronary transfer. We report a situation where we opted for primary coronary bypass grafting to avoid an obviously difficult coronary transfer, with successful outcome.
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Affiliation(s)
- K K Nair
- Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom
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