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Maeda T, Yoshizawa K, Mori O. Coronary artery bypass grafting in children aged under 1 year: a report of three cases. Cardiol Young 2023; 33:1772-1774. [PMID: 37038834 DOI: 10.1017/s1047951123000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We performed coronary artery bypass grafting with the internal thoracic artery in three infants. Grafts were patent in all cases. One patient was lost due to chronic heart failure. Coronary artery bypass grafting can be performed even in infancy, and early surgical intervention may be necessary when myocardial ischaemia is recognised.
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Affiliation(s)
- Toshi Maeda
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, 660-8550, Japan
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, 660-8550, Japan
| | - Otohime Mori
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, 660-8550, Japan
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2
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Alsoufi B. Coronary artery bypass grafting in infants and young children: default or alternative choice? Interact Cardiovasc Thorac Surg 2022; 35:6625660. [PMID: 35775945 PMCID: PMC9270863 DOI: 10.1093/icvts/ivac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children’s Hospital, University of Louisville School of Medicine , Louisville, KY, USA
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3
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Kitamura S. Direct plasty or bypass? That is still a question. Eur J Cardiothorac Surg 2022; 62:6594142. [PMID: 35639940 DOI: 10.1093/ejcts/ezac323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Soichiro Kitamura
- Chair, Board of Directors of Japan Cardiovascular Research Foundation, President Emeritus of National Cerebral and Cardiovascular Center
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4
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Chaszczewski KJ, Nicholson GT, Shahanavaz S, Dori Y, Gillespie MJ, O'Byrne ML, Rome JJ, Glatz AC. Stent Angioplasty for Post-Operative Coronary Artery Stenosis in Infants. World J Pediatr Congenit Heart Surg 2022; 13:203-207. [PMID: 35238698 DOI: 10.1177/21501351221074617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION While frequently performed in the adult population, percutaneous coronary artery stent angioplasty (CSA) in infants is rare. CSA in infants is challenging because of limited options in terms of appropriately sized (length and diameter) stents, concern about stenting vessels with significant growth potential and limited data regarding durability of benefit. We report a multicenter case series of infants who underwent CSA. METHODS A multicenter, retrospective case series of infants who underwent percutaneous CSA to treat post-operative coronary artery stenoses was performed. RESULTS Six infants from 3 institutions who underwent post-operative CSA were identified. The anatomic diagnoses were d-transposition of the great arteries in 3 cases, anomalous left coronary artery from the pulmonary artery in 2 and supravalvar aortic stenosis in 1. All infants were critically ill at the time of CSA. Diameters of coronary artery stents used ranged from 2.25 to 2.75 mm. There were no procedural complications. All stents were patent immediately after placement and the clinical condition improved or stabilized in all patients. Follow-up angiography was available for 3 patients at 4 to 16 months post-CSA, at which time 67% (2/3) remained patent. CONCLUSION CSA is a feasible and effective therapy for critically ill infants with post-surgical coronary obstruction. Treatment appears to allow at least short-term reperfusion to facilitate recovery of ventricular function and potential development of collateral circulation when longer-term stent patency is not achieved. Longer-term stent patency and coronary artery health remain unanswered questions.
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Affiliation(s)
- Kasey J Chaszczewski
- 5506Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Section of Pediatric Cardiology, The Herma Heart Institute, Milwaukee, WI, USA.,6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - George T Nicholson
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. Work completed at: Department of Pediatrics, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Yoav Dori
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew J Gillespie
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael L O'Byrne
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,6567Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan J Rome
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew C Glatz
- 6572Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,6567Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Tran A, Kochilas L, Thomas AS, Aggarwal V. Long-term outcomes after repair for anomalous right coronary artery from the pulmonary artery. Cardiol Young 2022; 33:1-5. [PMID: 35179109 PMCID: PMC9385887 DOI: 10.1017/s1047951122000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anomalous right coronary artery from pulmonary artery (ARCAPA) is a rare congenital heart disease that can lead to abnormal coronary perfusion and a need for surgical repair. Here, we report the outcomes of patients who underwent ARCAPA surgery within the Pediatric Cardiac Care Consortium (PCCC), a North American registry of interventions for paediatric heart diseases. We queried the PCCC for patients undergoing surgical repair for ARCAPA at <18 years of age between 1982 and 2003. Outcomes were obtained from the PCCC and after linkage with the National Death Index (NDI) and the Organ Procurement and Transplantation Network (OPTN) through 2019. Twenty-four patients (males: 15) were identified having surgery for ARCAPA at a median age of 5.8 (IQR 2.7-10.3) years. Of them, 23 cases were considered "simple" (without major intracardiac disease) and one "complex" (co-existing with tetralogy of Fallot). Five patients presented with symptoms [chest pain (1), dyspnoea on exertion (2) or history of syncope (2)]; while the remaining 19 patients were referred for evaluation of either murmur or co-existing CHD. There was no in-hospital mortality after the surgical repair. Fourteen patients had sufficient identifiers for NDI/OPTN linkage; among them, only one death occurred from unrelated non-cardiac causes within a median period of 19.4 years of follow-up (IQR: 18-24.6). Outcomes were excellent after reimplantation up to 25 years later and further longitudinal monitoring is important to understand the interaction of pre-existing coronary pathology with the effects of ageing.
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Affiliation(s)
- Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Amanda S Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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Kitamura S, Tachimori H, Murakami A, Kawata H, Ichikawa H, Miyata H. Mortality analysis of arterial switch operation for transposition of the great arteries with and without ventricular septal defect. Eur J Cardiothorac Surg 2021; 61:797-804. [PMID: 34939093 DOI: 10.1093/ejcts/ezab545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the 90-day mortality and effect of rescue or urgent coronary revascularization in children undergoing arterial switch operation for transposition of the great arteries with and without ventricular septal defect. METHODS The 90-day mortality, risk factors for mortality and outcome of rescue or urgent coronary revascularization were analysed using 8 years of data from the Japan Cardiovascular Surgical Database. We only included patients with full data for all analyses. RESULTS A total of 1084 patients (median weight: 3.0 kg; interquartile range: 2.8-3.3) underwent arterial switch operation at a median age of 10 days (interquartile range: 7-14). The 90-day mortality (5.2%, n = 56) was ∼1.6-fold higher than 30-day mortality (3.2%, n = 35). The cause was cardiac origin in 84% of non-survivors. Fifty-nine of the 1034 patients (5.7%) required extracorporeal membrane oxygenation (ECMO), with successful weaning in 44% (n = 26). Univariable or multivariable analyses revealed the following risk factors for mortality: body weight at operation <2.5 kg, aortic cross-clamp time, cardiac events and ECMO (P < 0.005-0.001). Ventricular septal defect was not a risk factor.Thirteen patients (1.2%) had either rescue or urgent coronary revascularization with salvage rates of 25% (2/8) and 100% (5/5), respectively. Only 5 ECMO patients (8%) underwent coronary revascularization with 1 survivor. CONCLUSIONS The 90-day mortality represented perioperative outcomes better than 30-day mortality. Patients on ECMO, which extended the survival time, had 56% 90-day mortality. Coronary revascularization showed a salvaging effect, although the case number was small.Subj collection: 116, 137, 141.
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Affiliation(s)
- Soichiro Kitamura
- Japan Cardiovascular Research Foundation, Osaka, Japan.,National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hisateru Tachimori
- Keio University School of Medicine, Tokyo, Japan.,The University of Tokyo, Tokyo, Japan
| | | | | | | | - Hiroaki Miyata
- Keio University School of Medicine, Tokyo, Japan.,The University of Tokyo, Tokyo, Japan
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Burkhart HM, Nakamura Y, Mir A. Commentary: Arterial switch operation: It's the little things that count. JTCVS Tech 2021; 10:446-447. [PMID: 34977779 PMCID: PMC8691824 DOI: 10.1016/j.xjtc.2021.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Harold M. Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Yuki Nakamura
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Arshid Mir
- Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
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Sarıoğlu T, Doğan A, Yalçınbaş Y, Erek E, Arnaz A, Türköz R, Oktay A, Saygılı A, Altun D, Yüksek A, Boz M, Sarıoğlu A. Surgical procedures for coronary arteries in pediatric cardiac surgery: Risk factors and outcomes. J Card Surg 2021; 36:2289-2299. [PMID: 33797801 DOI: 10.1111/jocs.15547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data exist regarding the coronary revascularization procedures needed during the repair of several congenital and pediatric cardiac malformations. We aimed to determine risk factors for in-hospital mortality and long-term outcomes of various pediatric coronary revascularization procedures. METHODS We retrospectively reviewed the records of 32 consecutive pediatric patients who underwent coronary revascularization procedures at our institution between May 1995 and June 2020. In-hospital mortality, risk factors, surgical indications, revascularization patency, and mid- and long-term follow-up data were investigated. Patients were categorized into the coronary artery bypass grafting (n = 11) and other coronary artery procedure (n = 21) groups. RESULTS The median age and weight of patients at the time of surgery were 9 months and 4.8 kg, respectively. There were five in-hospital deaths (5/32, 15.6%). The mortality rates were 27.2% (3/11) in the coronary artery bypass grafting group and 9.5% (2/21) in the other coronary artery procedure group (p = .206; 95% confidence interval: 0.496-25.563). The mortality rates for planned and rescue procedures were 8.3% (2/24) and 37.5% (3/8) (p = .06), respectively. The median follow-up time was 12.5 years. Control imaging studies for coronary patency were performed in 70.3% (19/27) of surviving patients. The overall coronary patency rate was 94.7% (18/19). CONCLUSIONS Pediatric coronary revascularization procedures with elective-planned indications can be performed with good outcomes. Young age and rescue and emergency procedures may carry an increased risk of in-hospital mortality, although not found to be statistically significant. Surviving patients require lifelong follow-up regarding the patency of reperfused coronary arteries.
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Affiliation(s)
- Tayyar Sarıoğlu
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Yusuf Yalçınbaş
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Ahmet Arnaz
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Rıza Türköz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayla Oktay
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Arda Saygılı
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Dilek Altun
- Department of Anesthesiology and Reanimation, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Adnan Yüksek
- Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Murat Boz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayşe Sarıoğlu
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
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Kreutzer C, Bastianelli G, Chiostri B, Gutierrez G, Klinger DA, Vaccarino G. CABG With Internal Thoracic Artery in Children With Congenital Heart Defects: A Good Option When It Is the Only One. World J Pediatr Congenit Heart Surg 2020; 11:748-752. [PMID: 33164689 DOI: 10.1177/2150135120940151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Christian Kreutzer
- Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Gustavo Bastianelli
- Division of Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Benjamin Chiostri
- Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Guillermo Gutierrez
- Division of Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Daniel Alberto Klinger
- Division of Pediatric Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Guillermo Vaccarino
- Division of Cardiovascular Surgery, 218809Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
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Ma K, Qi L, Yuan J, Zhang B, Yuan X, Fan T, Mao F, Lin Y, Wang G, Li S, Zhang T, Meng H, Pang K. Anatomic Repair of Left Main Coronary Artery Atresia: Coronary Ostioplasty With Autologous Pulmonary Artery. Can J Cardiol 2020; 37:887-894. [PMID: 33144173 DOI: 10.1016/j.cjca.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Left main coronary arterial (LMCA) atresia is a rare coronary arterial anomaly with extremely limited data on the optimal management. We aimed to report our single-surgeon experience of the ostioplasty in patients with LMCA atresia. METHODS From July 2018 to December 2019, pediatric patients who presented with LMCA atresia and subsequently underwent surgical coronary ostioplasty were recruited into this retrospective study. Concomitant mitral repair was applied when the regurgitation was moderate or more severe. RESULTS A total of 9 patients diagnosed with LMCA atresia were included. Mitral regurgitation was found in all of them, including 6 (66.7%) severe, 1 (11.1%) moderate, and 2 (22.2%) mild. In addition to ischemic lesions, which were found in 7 (77.8%) patients, structural mitral problems were also common (presented in 7 [77.8%] patients). All the patients underwent coronary ostioplasty with autologous pulmonary arterial patch augmenting the anterior wall of the neo-ostium. Mean aortic cross clamp time and cardiopulmonary bypass time was 88.1 ± 18.9 and 124.6 ± 23.6 minutes, respectively. During a median of 10.9 (range: 3.3 to 17.2) months' follow-up, there was only 1 death at 5 months after surgery. All survivors were recovered uneventfully with normal left-ventricular function; however, with 4 (50.0%) having significant recurrence of mitral regurgitation. CONCLUSIONS With favourable surgical outcomes, coronary ostioplasty for LMCA atresia may be an option of revascularization. Structural mitral problems presented in majority patients, resulting in the requirement of concomitant mitral repair. However, the optimal technique of mitral repair remains unclear.
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Affiliation(s)
- Kai Ma
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Lei Qi
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Jianhui Yuan
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Benqing Zhang
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Xingang Yuan
- Paediatric Cardiac Surgery Center, Fuwai Central China Cardiovascular Hospital, Zhengzhou, The People's Republic of China
| | - Taibing Fan
- Paediatric Cardiac Surgery Center, Fuwai Central China Cardiovascular Hospital, Zhengzhou, The People's Republic of China
| | - Fengqun Mao
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Ye Lin
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Guanxi Wang
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Shoujun Li
- Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China.
| | - Tingting Zhang
- Department of Pediatric Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Hong Meng
- Department of Pediatric Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
| | - Kunjing Pang
- Department of Pediatric Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, The People's Republic of China
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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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