1
|
Salsano A, Liao J, Miette A, Capoccia M, Mariscalco G, Santini F, Corno AF. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis. Open Med (Wars) 2021; 16:375-386. [PMID: 33748422 PMCID: PMC7957190 DOI: 10.1515/med-2021-0242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/05/2021] [Accepted: 02/03/2021] [Indexed: 12/18/2022] Open
Abstract
Background Kawasaki disease (KD) is a systemic inflammatory condition occurring predominantly in children. Coronary artery bypass grafting (CABG) is performed in the presence of inflammation and aneurysms of the coronary arteries. The objectives of our study were to assess which CABG strategy provides better graft patency and early and long-term outcomes. Methods A systematic review using Medline, Cochrane, and Scopus databases was performed in February 2020, incorporating a network meta-analysis, performed by random-effect model within a Bayesian framework, and pooled prevalence of adverse outcomes. Hazard ratios (HR) and corresponding 95% credible intervals (CI) were calculated by Markov chain Monte Carlo methods. Results Among 581 published reports, 32 studies were selected, including 1,191 patients undergoing CABG for KD. Graft patency of internal thoracic arteries (ITAs), saphenous veins (SV), and other arteries (gastroepiploic artery and radial artery) was compared. ITAs demonstrated the best patency rates at long-term follow-up (HR 0.33, 95% CI: 0.17–0.66). Pooled prevalence of early mortality after CABG was 0.28% (95% CI: 0.00–0.73%, I2 = 0%, tau2 = 0), with 63/1,108 and 56/1,108 patients, undergoing interventional procedures and surgical re-interventions during follow-up, respectively. Pooled prevalence was 3.97% (95% CI: 1.91–6.02%, I2 = 60%, tau2 = 0.0008) for interventional procedures and 3.47% (95% CI: 2.26–4.68%, I2 = 5%, tau2 <0.0001) for surgical re-interventions. Patients treated with arterial, venous, and mixed (arterial plus second venous graft) CABG were compared to assess long-term mortality. Mixed CABG (HR 0.03, 95% CI: 0.00–0.30) and arterial CABG (HR 0.13, 95% CI: 0.00–1.78) showed reduced long-term mortality compared with venous CABG. Conclusions CABG in KD is a safe procedure. The use of arterial conduits provides better patency rates and lower mortality at long-term follow-up.
Collapse
Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, L.go Rosanna Benzi, 10, 16143, Genoa, Italy.,Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Jingda Liao
- Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom.,Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Ambra Miette
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, L.go Rosanna Benzi, 10, 16143, Genoa, Italy.,Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Massimo Capoccia
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Giovanni Mariscalco
- Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom.,Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, L.go Rosanna Benzi, 10, 16143, Genoa, Italy.,Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Antonio F Corno
- Houston Children Heart Institute, Hermann Children's Hospital, Houston, Texas, United States of America.,University Texas Health, McGovern Medical School, Houston, Texas, United States of America
| |
Collapse
|
2
|
Bonilla-Ramirez C, Molossi S, Sachdeva S, Reaves-O'Neal D, Masand P, Mery CM, Caldarone CA, McKenzie ED, Binsalamah ZM. Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation. J Thorac Cardiovasc Surg 2021; 162:1191-1199. [PMID: 33541731 DOI: 10.1016/j.jtcvs.2020.12.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Anomalous aortic origin of a coronary artery (AAOCA) can be associated with myocardial ischemia and sudden cardiac arrest. We compared outcomes data of patients who underwent transection and reimplantation (TAR) and patients who underwent an unroofing. METHODS Patients who presented to the Coronary Artery Anomalies Program were evaluated and managed following a standardized approach. Anatomy was determined using computed tomography angiography, myocardial perfusion using advanced stress imaging, and surgical intervention according to anatomic features. RESULTS Sixty-one patients underwent surgical repair of AAOCA between 2012 and 2019: 16 (26%) patients underwent TAR of the anomalous coronary without an aortic button and 45 (74%) patients underwent coronary unroofing. Compared with patients who underwent an unroofing, patients who underwent TAR had similar intramural length (5 mm with interquartile range of 4-7.7 vs 6 mm with interquartile range of 5-7; P = .6). One patient with an anomalous right coronary underwent coronary artery bypass grafting after TAR because of persistent postoperative ischemic changes. One patient with unroofing of an anomalous left coronary artery presented with recurrent aborted sudden cardiac death and underwent subsequent TAR, without further events. At last follow-up, 15 of 16 patients (94%) who underwent TAR and 42 of 45 (93%) patients who underwent an unroofing were released to unrestricted exercise activities. CONCLUSIONS Coronary artery TAR is a useful surgical alternative for AAOCA when there is a course below the commissure, when unroofing does not relocate the ostium to the appropriate sinus, or when unroofing results in compression by the intercoronary pillar.
Collapse
Affiliation(s)
- Carlos Bonilla-Ramirez
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Dana Reaves-O'Neal
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Prakash Masand
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Section of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Tex
| | - Christopher A Caldarone
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - E Dean McKenzie
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Ziyad M Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
| |
Collapse
|
3
|
Komarov R, Ismailbaev A, Chragyan V, Kadyraliev B, Sá MPBO, Ruhparwar A, Weymann A, Zhigalov K. State-of-the-Art Pediatric Coronary Artery Bypass Surgery: a Literature Review. Braz J Cardiovasc Surg 2020; 35:539-548. [PMID: 32864935 PMCID: PMC7454630 DOI: 10.21470/1678-9741-2019-0366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies. Methods We analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review. Results The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P<0.001). Acute and late coronary events after arterial switch operation for the transposition of the great arteries, anomalous origin of the left coronary artery from the pulmonary artery, and left main coronary artery atresia are the main congenital heart diseases where surgical correction involves interventions on the coronary arteries. Conclusion The internal thoracic artery is a reliable and durable conduit that demonstrates proven growth potential in children.
Collapse
Affiliation(s)
- Roman Komarov
- Department of Cardiovascular Surgery, I.M. Sechenov University Hospital, First Moscow State Medical University, Moscow, Russia
| | - Alisher Ismailbaev
- Department of Cardiovascular Surgery, I.M. Sechenov University Hospital, First Moscow State Medical University, Moscow, Russia
| | - Vagi Chragyan
- Department of Cardiovascular Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russia
| | - Bakytbek Kadyraliev
- Department of Cardiovascular Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russia
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, PE, Brazil
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
4
|
Kitamura S, Tsuda E. Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease. CHILDREN-BASEL 2019; 6:children6020016. [PMID: 30700042 PMCID: PMC6406243 DOI: 10.3390/children6020016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/30/2022]
Abstract
As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions can be done with the surgical coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures. However, the characteristics of coronary-arterial lesions caused by KD significantly differ from atherosclerotic coronary disease in adults. Therefore, it is much more difficult to determine the optimal time and selection of a coronary-artery revascularization procedure for KD sequelae. CABG using the internal thoracic artery has been accepted as a very useful and beneficial procedure since the mid-1980s, even in small children. Although the use of PCI in the late period can be effective in some adolescent and adult patients, the small vessel size and severe coronary-artery calcification are often limiting factors for its use in children. Therefore, CABG is a better approach for severe leftanterior descending artery and multiple-vessel disease in children and adolescents with KD coronary sequelae. Good coronary revascularization can improve the long-term outcomes of patients with severe KD complications.
Collapse
Affiliation(s)
- Soichiro Kitamura
- National Cerebral and Cardiovascular Center, Department of Cardiovascular surgery, Suita,Osaka 565-8565, Japan.
| | - Etsuko Tsuda
- National Cerebral and Cardiovascular Center, Department of Pediatric cardiology, Suita, Osaka 565-8565, Japan.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Ochi M. Review: surgical treatment of giant coronary aneurysms in pediatric patients with Kawasaki disease. Gen Thorac Cardiovasc Surg 2017; 66:121-129. [PMID: 29214375 DOI: 10.1007/s11748-017-0877-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/29/2017] [Indexed: 02/08/2023]
Abstract
In Kawasaki disease (KD), giant coronary aneurysms in the proximal segments of the coronary arteries have long been among the serious complications associated with acute myocardial infarction. To treat myocardial ischemia in children, Kitamura et al. first performed coronary artery bypass grafting in a pediatric patient using an autologous saphenous vein. In the early 1980s, they began to use the internal thoracic artery (ITA) as a bypass graft to the left anterior descending artery, which later was proven to improve long-term life expectancy with its favorable long-term patency, as well as growth potential. Thus, the excellent characteristics of the ITA have come to be widely known among pediatric cardiac surgeons, and a growing number of coronary bypass surgery procedures using the ITA are now being performed worldwide. Although a longer follow-up with more patients is necessary, downsizing reconstructive procedure may be a treatment of choice for giant aneurysms of non-LAD territories to improve coronary circulation. The efficacy of surgical treatment for giant coronary aneurysms in pediatric patients with Kawasaki disease is now well established. Pediatric coronary artery bypass grafting using the ITA, either single or bilateral, can be safe not only for patients with Kawasaki coronary disease but also for infants with congenital coronary lesions.
Collapse
Affiliation(s)
- Masami Ochi
- Nippon Medical School, 1-56-11 Kitasenzoku Ohta-ku, Tokyo, 145-0062, Japan.
| |
Collapse
|
7
|
Kitamura S. Pediatric Coronary Artery Revascularization Surgery: Development and Effects on Survival, Cardiac Events and Graft Patency for Children With Kawasaki Disease Coronary Involvements. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e3875. [PMID: 26848378 PMCID: PMC4733294 DOI: 10.5812/ijp.3875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Abstract
Pediatric coronary artery bypass surgery gained wide acceptance with the introduction of internal thoracic arteries (ITAs) for bypass operations for post Kawasaki disease (KD) lesions. The technique is now established as the standard surgical choice, and its safety even in infancy, graft patency, growth potential, graft longevity and clinical efficacy have been well documented. In this article the author reviews the development of pediatric coronary bypass as the main indication for the treatment of coronary lesions due to KD. I believe that coronary revascularization surgery in pediatric population utilizing uni- or bilateral ITAs is the current gold-standard as the most reliable treatment, although percutaneous coronary intervention with or without a stent has been tried with vague long-term results in children.
Collapse
Affiliation(s)
- Soichiro Kitamura
- National Cerebral and Cardiovascular Center, Osaka, Japan
- Corresponding author: Soichiro Kitamura, National Cerebral and Cardiovascular Center, Osaka, Japan. E-mail:
| |
Collapse
|
8
|
Tsuda E. Coronary artery bypass grafting for coronary artery stenosis caused by Kawasaki disease. Expert Rev Cardiovasc Ther 2014; 7:533-9. [DOI: 10.1586/erc.09.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Yuan SM. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med 2012; 7:19796. [PMID: 23226165 PMCID: PMC3514494 DOI: 10.3402/ljm.v7i0.19796] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/29/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this article is to make an evaluation on the clinical features of patients with Kawasaki disease who require a cardiac surgical procedure including coronary artery bypass grafting, coronary arterial aneurysmorrhaphy or heart transplantation. METHODS English literature of Kawasaki disease for cardiac surgery (1990-2011) was retrieved in the Pubmed database. The clinical features of the patient setting from the representative articles were collected and analyzed. RESULTS Patients with Kawasaki disease were very young, with some requiring a cardiac surgical procedure at a very early age. The interval between the onset and the surgical operation was 9.5±9.4 years. The prevalence of myocardial infarction and re-infarction was high. Giant aneurysm, critical stenosis with calcification and thrombus formation of the coronary arteries often warrant coronary artery bypass, heart transplantation or coronary arterial aneurysm plication. The left internal mammary artery to the left anterior descending coronary artery was the most commonly used graft in coronary artery bypass. Graft patency rate was 82.4% at 21.4±32.3 (range 0.1-252) month follow-up. The early and late mortalities of this patient setting were 0.6 and 3.0%, respectively. CONCLUSIONS Patients with Kawasaki disease may develop coronary artery lesions prone to aneurysmal formation with calcification and thrombus and may require coronary artery bypass at a very early age. With the left internal mammary artery as the first choice of bypass graft, the long-term patency and patient survival was satisfactory.
Collapse
Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China.
| |
Collapse
|
10
|
Domoto S, Nakano K, Kodera K, Asano R, Fujibayashi M, Takeuchi Y. Histopathology of the longest-lived saphenous vein graft in a patient with Kawasaki disease. Ann Thorac Surg 2012; 93:2065-7. [PMID: 22632509 DOI: 10.1016/j.athoracsur.2011.10.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 10/15/2011] [Accepted: 10/25/2011] [Indexed: 11/25/2022]
Abstract
The patency rate of saphenous vein grafts (SVGs) for children with Kawasaki disease (KD) tends to decline during the early years after coronary artery bypass grafting (CABG). Although degenerative changes have been considered the main cause of SVG occlusion, there have been no reports on the histopathologic features of the SVG in patients with KD. We herein describe a redo off-pump total arterial revascularization in a 43-year-old man with KD, 34 years after the first CABG using SVG. The histopathologic examination of the longest-lived SVG demonstrated that graft occlusion was mainly caused by the diffuse intimal hyperplasia.
Collapse
Affiliation(s)
- Satoru Domoto
- Department of Cardiovascular Surgery, Tokyo Women's Medical University Medical Center East, Nishiarai Heart Center Hospital, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
11
|
Ebata R, Abe J, Yasukawa K, Hamada H, Higashi K, Suwazono Y, Saito H, Terai M, Kohno Y. Increased production of vascular endothelial growth factor-d and lymphangiogenesis in acute Kawasaki disease. Circ J 2011; 75:1455-62. [PMID: 21483160 DOI: 10.1253/circj.cj-10-0897] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is characterized by systemic vasculitis with tissue edema. During the healing process of inflammation, lymphangiogenesis is essential for reducing tissue edema. One potential responsible candidate for the induction of lymphangiogenesis in the healing process of acute KD is vascular endothelial growth factor-D (VEGF-D). METHODS AND RESULTS Sequential changes in serum VEGF-D levels in patients with acute KD (n = 47) using an enzyme-linked immunosorbent assay were investigated. Cross-sectional areas of lymphatic vessels and VEGF-D protein expression were evaluated immunohistochemically in cardiac tissues of patients (n = 6) who died of KD. Regulation of VEGF-D messenger RNA (mRNA) expression in cultured fibroblasts was assessed using quantitative real-time polymerase chain reaction. Serum VEGF-D levels increased after intravenous immunoglobulin therapy in patients with acute KD (P < 0.001). In addition, they were significantly lower in patients with coronary artery lesions (CAL) than in those without CAL (P < 0.05). The cross-sectional areas of lymphatic vessels in cardiac tissues were enlarged in patients with acute KD. VEGF-D protein was detected on the endothelium of the enlarged lymphatic vessels. In vitro, tumor necrosis factor- significantly down-regulated VEGF-D mRNA expression in cultured fibroblasts (P = 0.004). CONCLUSIONS This study indicates that the production of VEGF-D increases and is related to lymphangiogenesis in patients with acute KD. In addition, low VEGF-D production appears to be associated with the development of CAL.
Collapse
Affiliation(s)
- Ryota Ebata
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Michishita I. The final answer? For the treatment of saphenous vein graft disease, drug-eluting stents vs. bare-metal stents. Circ J 2011; 75:261-2. [PMID: 21228495 DOI: 10.1253/circj.cj-10-1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
13
|
Paredes N, Mondal T, Brandão LR, Chan AKC. Management of myocardial infarction in children with Kawasaki disease. Blood Coagul Fibrinolysis 2010; 21:620-31. [DOI: 10.1097/mbc.0b013e32833d6ec2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Muta H, Ishii M. Percutaneous coronary intervention versus coronary artery bypass grafting for stenotic lesions after Kawasaki disease. J Pediatr 2010; 157:120-6. [PMID: 20304414 DOI: 10.1016/j.jpeds.2010.01.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/07/2010] [Accepted: 01/21/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the long-term efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for stenotic lesions after Kawasaki disease. STUDY DESIGN Questionnaires were sent to pediatricians in Japan in hospitals with 100 or more beds. A total of 1637 questionnaires were sent, and 1347 (82%) were returned. The primary endpoints of the study were the composite of deaths from any cause and the Q-wave myocardial infarction. The secondary endpoints were the repeat-revascularization for the target vessel. RESULTS A total of 67 patients underwent PCI and 81 patients underwent CABG. Although the rates of the primary endpoints did not differ between the groups (hazard ratio 1.35 [95% confidence interval 0.29 to 6.32], P=.7), the rate of the secondary endpoints in the PCI group was significantly higher than that in the CABG group (hazard ratio 2.23 [95% confidence interval 1.04 to 4.76], P=.04). The benefit with CABG for the secondary endpoints was notable in patients younger than 12 years old, and who had ischemic change. CONCLUSIONS PCI after Kawasaki disease resulted in a lower efficacy in comparison to CABG because of increased repeat-revascularization procedures.
Collapse
Affiliation(s)
- Hiromi Muta
- Department of Pediatrics, Kurume University School of Medicine, Kurume, Japan.
| | | |
Collapse
|
15
|
Kuroi A, Imanishi T, Suzuki H, Ikejima H, Tsujioka H, Yoshikawa N, Akasaka T. Clinical Characteristics of Patients With Kawasaki Disease and Levels of Peripheral Endothelial Progenitor Cells and Blood Monocyte Subpopulations. Circ J 2010; 74:2720-5. [DOI: 10.1253/circj.cj-10-0317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Hideyuki Ikejima
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroto Tsujioka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| |
Collapse
|