Coronary artery bypass grafting in children

Arnaz, Ahmet; Sarıoğlu, Tayyar; Yalçınbaş, Yusuf Kenan; Erek, Ersin; Türköz, Rıza; Oktay, Ayla; Saygılı, Arda; Altun, Dilek; Sarıoğlu, Ayşe

doi:10.1111/jocs.13510

Cited by 19 publications

(21 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous therapeutic strategies including percutaneous coronary intervention (PCI), coronary bypass grafting, reparation of the congenital heart disease or lung‐heart transplantation were described in case reports of adults and young adults. There are only few reports about coronary bypass grafting in small kids . Percutaneous coronary intervention seems to be feasible and safe but no cases have been reported in a pediatric patient.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child

Butera

Mansour

Marco

2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Here, we report on the case of a 4-year-old child with large atrial septal defect (ASD) and severe pulmonary hypertension presenting an ischemic cardiomyopathy secondary to left main (LM) compression by a dilated pulmonary artery trunk. Despite of surgical treatment consisting in ASD closure and coronary artery bypass grafting, the patient was not weanable from ECMO. Control coronarography showed a near-occlusion of the left mammary bypass. A rescue percutaneous LM angioplasty with drug-eluting stent implantation was performed.

show abstract

Section: Discussionmentioning

confidence: 99%

“…There are only few reports about coronary bypass grafting in small kids. [6][7][8][9] Percutaneous coronary intervention seems to be feasible and safe 10 but no cases have been reported in a pediatric patient. Limitations of PCI in this population are the small diameter of the LM and the unknown outcome of the PCI during child growth.…”

Section: Discussionmentioning

confidence: 99%

Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child

Butera

Mansour

Marco

2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Although it occurs rarely nowadays, inadvertent transection of the ACA while opening the infundibulum is every surgeon's nightmare because it can result in serious myocardial infarction and operative death. In such cases, a CA bypass is required, and one should always use the internal mammary artery for longterm patency [21,22].…”

Section: Mortality and Coronary Artery Damagementioning

confidence: 99%

Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated

Pontailler

Bernard

Gaudin

et al. 2019

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

OBJECTIVES Repair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5–12% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit. METHODS We conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n = 76) presented with an abnormal CA. Mean follow-up time was 50 months (1 month–18 years). RESULTS The most frequent CA anomaly was the left descending artery arising from the right CA (n = 47, 61.8%). The median age at repair was 7.7 months (1.8 months–16 years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n = 35, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n = 3); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV/left ventricle (LV) pressure ratio and an RV/LV pressure ratio >2/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P = 0.0026, P = 0.0085, respectively), RVOT reoperations (P = 0.0002 for both) and reoperation for RVOT residual stenosis (P = 0.0002, P = 0.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was 100% at 1 year, 97% at 5 years and 84% at 10 and 15 years. CONCLUSIONS Repair of ToF and abnormal CA can be performed without an RV-PA conduit, with an acceptable low reintervention rate. The high early mortality rate in this series remains a concern. If any doubt remains about the surgical relief of the RVOT obstruction, the RV/LV pressure ratio should always be measured in the operating room.

show abstract

“…Furthermore, the IMA's blood flow has been more than adequate to meet the demands of the myocardium in these younger patients. Arnaz et al have reaffirmed that the IMA can be successfully utilized in infants, children, and adolescents during complex procedures, even when emergent revascularization is necessary, and should be the conduit of choice in these young patients.…”

mentioning

confidence: 99%

“…In this edition of the Journal, Arnaz et al report their experience with CABG surgery in 10 children ranging from 88 days to 15 years. The indications for CABG included complications related to the ASO and the Ross procedure and iatrogenic injuries due to the anomalous location of coronary arteries during TOF repairs.…”

mentioning

confidence: 99%

Coronary artery revascularization in infants, children, and adolescents: The internal mammary artery is still the conduit of choice

Lazar

2018

J Card Surg

View full text Add to dashboard Cite

In infants, children, and adolescents, the most common indication for coronary artery bypass graft surgery (CABG) has been Kawasaki disease or acquired familial hypercholesterolemia. However, pediatric CABG is now more commonly performed for coronary artery injuries which occur during or following arterial switch operations (ASO), the Ross procedure, and tetralogy of Fallot repairs (TOF).1-3 CABG has also been performed in adults who present with acquired coronary atherosclerotic disease and have congenital lesions such as TOF. 4In adult CABG surgery, the internal mammary artery (IMA) is the conduit of choice because of its superior long-term patency. However, in infants, children, and adolescents, concerns have been raised regarding the use of the IMA because of competitive flow, the smaller diameter of the IMA, the size of the target vessel, the need for the IMA to provide the entire blood supply for large areas of the myocardium, and the potential of the IMA for somatic growth.In this edition of the Journal, Arnaz et al 5 report their experience with CABG surgery in 10 children ranging from 88 days to 15 years. The indications for CABG included complications related to the ASO and the Ross procedure and iatrogenic injuries due to the anomalous location of coronary arteries during TOF repairs. Three patients died during the postoperative period, but none of the deaths were due to coronary ischemia. Eight patients received an IMA graft and two patients received saphenous vein grafts. Four of the eight IMA grafts underwent follow-up angiograms which showed patent IMA grafts in all patients.In two of these patients, the IMA grafts showed somatic growth after 9.5 and 18 years. None of the surviving seven patients had any recurrent angina, new Q waves, or a reduction in ejection fraction.Although the number of patients in this series is small, it confirms the results of other studies which have demonstrated that the IMA has excellent long-term patency and adapts well to somatic growth.

show abstract

Coronary artery bypass grafting in children

Abstract: Our study suggests that the IMA should be the graft of choice in children due to its growth potential and long-term patency.

Cited by 19 publications

References 22 publications

Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child

Emergency trans‐catheter coronary intervention for left main compression secondary to pulmonary hypertension in a 4‐year‐old child

Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated

Coronary artery revascularization in infants, children, and adolescents: The internal mammary artery is still the conduit of choice

Contact Info

Product

Resources

About