Twenty-Five-Year Outcome of Pediatric Coronary Artery Bypass Surgery for Kawasaki Disease

Kitamura, Soichiro; Tsuda, Etsuko; Kobayashi, Junjiro; Nakajima, Hiroyuki; Yoshikawa, Yoshiro; Yagihara, Toshikatsu; Kada, Akiko

doi:10.1161/circulationaha.108.840603

Cited by 117 publications

(127 citation statements)

References 33 publications

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“…50 The incidence of ITA reopening is unknown, however, in our series of CABG operations for Kawasaki disease in which angiographic evaluation was repeated more than 3 or 4 times from 1 month until later than 20 years after the operation; 18 (12%) of the 154 ITA grafts were judged as occluded early after the operation, most likely due to flow competition between the graft and the less stenotic coronary artery with aneurysmal dilation. At repeat angiography, 4 (22%) of these were found to be functioning in the late (3-5 years) postoperative period, with a resultant improvement of the ITA graft patency rate from 88% to 39 Late ITA recanalization was not rare, although the patient group in that study consisted of pediatric patients, so further studies will be needed to determine whether this is also true of adult patients. The sequence of the string phenomenon of arterial grafts is shown in Figure 1.…”

Section: Progression Of Coronary Artery Obstructive Diseasementioning

confidence: 96%

“…This is apparently the reason why the ITA graft remains patent and morphologically stable for a long duration after surgery, whereas the SVG tends to develop local narrowing with intimal hyperplasia and degenerative dilation, and eventually, atherosclerosis. 39 The ITA undergoes adaptive enlargement of its lumen in response to increased flow demand, as well as remodeling in response to decreased flow demand, resulting in a string-like shrinkage, both of which are endothelium-dependent phenomena. In 1992, my group first established a correlation between the ultimate ITA luminal diameter and the severity of proximal coronary stenosis following CABG.…”

Section: Progression Of Coronary Artery Obstructive Diseasementioning

confidence: 99%

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Physiological and Metabolic Effects of Grafts in Coronary Artery Bypass Surgery

Kitamura

2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary artery bypass grafting (CABG) surgery initially utilizing a saphenous vein graft (SVG) and later the internal thoracic artery (ITA) has gained world-wide acceptance as a highly effective operation that not only ameliorates angina pectoris, but also improves both cardiac function and patient longevity. On the other hand, percutaneous coronary intervention (PCI) utilizing metallic or drug-eluting stents has also obtained rapid and world-wide popularity as a less invasive method of treating coronary artery obstructive disease, and many randomized clinical trials (RCT) are being conducted to compare the efficacy of CABG vs. PCI from the various clinical aspects of the different grades of illness. The endpoints of the trials include the occurrence of death, myocardial infarction, cerebral stroke and need for reintervention.I have long questioned why an ITA -left anterior descending artery (LAD) bypass can prolong a patient's life better than a SVG -LAD bypass, 1-3 why the use of bilateral ITAs can prolong life better than unilateral use, 4,5 and why CABG using the ITA can prolong life better than PCI in specific groups of patients, such as those with diabetes and elderly patients with triple-vessel disease, as has been demonstrated in the recent prospective RCT or retrospective risk-matched clinical studies. 6-9Furthermore, I have long considered that there are fundamental benefits of CABG with the use of ITAs, not only due to graft patency alone, but also due to differences in the endothelial metabolic effects of the ITA, SVG and coronary stents, particularly in patients with severe coronary endothelial dysfunction, such as multivessel coronary artery disease, 8 elderly patients 9 and diabetic patients. 6,7 Here, I review previous publications on these topics, while focusing on the physiological and metabolic function of the graft transplanted into the coronary artery systems by CABG surgery. Intraoperative Graft Flow and Postoperative Coronary Flow ReserveThe ITA graft flow is about 50-60% of the SVG flow when measured intraoperatively by electromagnetic flow meter 10 or a transit-time Doppler flow meter. 11 The limited flow of the ITA graft is attributed to its small luminal caliber and the length of the graft originating from the subclavian artery; both of which result in higher physiologic conduit resistance than with the SVG, which has a larger lumen and shorter length, usually originating from the ascending aorta. When CABG is performed under cardiopulmonary bypass and anoxic cardiac arrest, ITA malperfusion syndrome 12 occurs very rarely, which is when the ITA graft flow cannot meet the increased post-cardiac arrest hyperemic flow demand. In this setting, either a pharmacological or surgical addition is required to compensate for the hypoperfusion. Pharmacologically, an increase in the perfusion pressure and relief from coronary and/or graft spasm are necessary, and can be achieved with the administration...

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Section: Progression Of Coronary Artery Obstructive Diseasementioning

confidence: 96%

Section: Progression Of Coronary Artery Obstructive Diseasementioning

confidence: 99%

Physiological and Metabolic Effects of Grafts in Coronary Artery Bypass Surgery

Kitamura

2011

Circ J

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“…216 a. Graft Patency The patency of internal thoracic artery grafts, that are the only available grafts for CABG in children, is as high as 87% overall, and 91%, 100%, and 84% when grafted to the left anterior descending artery, the left circumflex artery, and the right coronary artery, respectively, at 20 years after CABG. 217 …”

Section: Outcome Of Surgerymentioning

confidence: 99%

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2013)

2014

Circ J

210

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“…Involvement of the graft vessel from the episode of KD is very unlikely. Kitamura et al 5 have shown that bypass grafting can be performed in pediatric patients as young as 1 year of age, with no operative or hospital deaths, and a 25-year patient survival rate of 95%. Cardiac event-free survival at 25 years was 60%, with the majority of events being PCI or reoperation.…”

Section: Article See P 60mentioning

confidence: 99%

Kawasaki Disease

McCrindle

2009

Circulation

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Twenty-Five-Year Outcome of Pediatric Coronary Artery Bypass Surgery for Kawasaki Disease

Cited by 117 publications

References 33 publications

Physiological and Metabolic Effects of Grafts in Coronary Artery Bypass Surgery

Physiological and Metabolic Effects of Grafts in Coronary Artery Bypass Surgery

Guidelines for Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease (JCS 2013)

Kawasaki Disease

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