Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease

Abstract

The long-term outcome of myocardial revascularization by coronary artery bypass grafting in patients with severe coronary obstruction caused by Kawasaki disease is largely unknown. A multicenter foUow-up study was performed in 1991. A total of 168 patients with Kawasaki disease (127 male [75.6 %] and 41 female patients [24.4%]) who had undergone coronary bypass grafting were enroUed. Obstructive coronary artery disease affected the left main trunk in 11.8 %, the right coronary artery in 77.6%, the left anterior descending in 87.6%, and the left circumflex in 25.9%. Old myocardial infarction was noted in 46.0 % of the patients. Fifty-four patients (32 %, 12.4 ± 9.8 years) underwent bypass grafting with saphenous vein grafts alone. The remaining 114 patients (68%, 9.8 ± 7.1 years) received at least one internal thoracic artery graft to the left anterior descending coronary artery. Gastroepiploic artery grafts were used in 12 patients. There were no significant differences between the saphenous vein and internal thoracic artery groups in the mean age at operation (12.4 versus 9.8 years), female ratio (22 % versus 25 %), the number of patients over 20 years of age (9.3 % versus 9.6 %), previous history of infarction (51.9% versus 41.2 %), impaired left ventricular function (ejection fraction < 0.5) (13.0 versus 11.4%), left main trunk disease (11.1 % versus 10.5%), the number of vessels involved (2.2 ± 0.8 versus 2.0 ± 0.6 per patient), or the mean number of grafts used (1.7 ± 0.7 versus 1.7 ± 0.7 per patient). The operative death rate was also the same in the two groups (1.9% versus 0 %), but the late cardiac death rate was significantly higher in the saphenous vein graft group (13.0%) than in the internal thoracic artery group (0.9 %) (p < 0.003). Actuarial analysis showed a significantly higher survival in the internal thoracic artery group (98.7% ± 1.2% versus 81.6% ± 7.0%, p < 0.05) at 90 months after the operation. Late death was strongly related to the absence of an internal thoracic artery graft (p < 0.003) and to the age at the time of operation (p < 0.05). The actuarial patency rate was significantly higher for arterial grafts (77.1 % ± 1.1 %, n =151) than for vein grafts (46.2% ± 6.3%, n =126) 85 months after the operation (p < 0.003). Arterial grafts were used for the non-left anterior descending coronary arteries in only 41 of 155 grafts (26.5 %); in contrast, vein grafts were used in 85 of 133 grafts (63.9 %) (p < 0.005 to 0.001). However, the actuarial patency rate was significantly higher for arterial grafts (81.4% ± 8.2%, Soichiro Kitamura, MD a (by invitation), Yoichi Kameda, MD a (by invitation), Toshio Seki, MDa (by invitation), Kanji Kawachi, MDa (by invitation), Nara, Japan, Masahiro Endo, MDb (by invitation), Yasuo Takeuchi, MDC (by invitation), Tomisaku Kawasaki, MDd (by invitation)

Searching for the cause of Kawasaki disease — cytoplasmic inclusion bodies provide new insight

“…Meanwhile, the scientific and Technical Advisory Committee (sTAC), an independent technical-oversight body, enlisted leading scientists not only from global centres of expertise but also from disease-endemic regions and industry. This kind of cooperation bestowed research credibility and helped make TDr a forerunner of the public-private partnerships (PPPs) that would emerge around the turn of the millennium [6][7][8][9] .…”

“…In severe cases, KD leads to heart attacks, coronary-artery-aneurysm rupture and/or sudden death 5,6 . Affected children can require interventions, such as angioplasty or stent placement, coronaryartery-bypass surgery or, rarely, heart transplantation [7][8][9][10] . Because the features of KD resemble those of other febrile childhood illnesses and as there is no specific diagnostic test for KD, diagnosis can be delayed or never established, which results in a higher likelihood that coronary-artery abnormalities will develop 11 .…”

Rescue Coronary Artery Bypass Grafting in a Neonate After Arterial Switch Operation: A Temporary or a Lifetime Solution?

“…Coronary complications and myocardial revascularization techniques have been extensively described after ASO for D-TGA. [4][5][6][7][8][9] Surgical procedures in neonates, which require reimplantation and manipulation of coronary arteries, may be associated with potential serious complications especially in case of abnormalities of origin, position, or distribution of these arteries. 1,9 During the last two decades, CABG has been described as a successful rescue option in neonates with D-TGA who had coronary artery ischemia at the time of ASO and has favorably impacted the clinical course of those patients with coronary insufficiency.…”

“…[4][5][6] In particular, the utilization of the left internal thoracic artery for CABG in children seems to have the higher patency rate as well as demonstrated anastomotic and linear growth potential. 7 Nonetheless there is still concern about its patency in patients younger than three years of age. 4,8 Moreover, it is well known that children rarely report symptoms and noninvasive methods have not been predictive of coronary abnormalities even when a severe coronary lesion is present thus making the follow-up and the diagnosis of myocardial ischemia or myocardial perfusion impairment challenging.…”

“…[2][3] Coronary artery bypass grafting (CABG) is considered a good surgical option for patients who had an iatrogenic coronary lesion after coronary translocation that did not resolve after conventional surgical maneuvers. [4][5][6][7] We present a case of a neonate with D-TGA, ventricular septal defect, and abnormal coronary artery pattern who underwent successful rescue CABG for acute ischemia at the time of ASO. Early and long-term clinical results are detailed.…”