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Long-term clinical outcomes of coronary artery bypass grafting in young children with Kawasaki disease

Part of: Surgery

Published online by Cambridge University Press:  02 July 2021

Yujin Kwak
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University ‘Children’s’ Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Jae Gun Kwak
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University ‘Children’s’ Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Sungkyu Cho
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University ‘Children’s’ Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Woong-Han Kim*
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University ‘Children’s’ Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
*
Author for correspondence: Woong-Han Kim, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Seoul National University ‘Children’s’ Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. Tel: +82-2-2072-3637; Fax: +82-2-764-3664. E-mail: woonghan@snu.ackr

Abstract

Background:

Although coronary artery bypass grafting is not frequently performed in children, Kawasaki disease is one of the most common indications for coronary artery bypass grafting in children. Here, we reviewed the long-term clinical outcomes including graft patency after coronary artery bypass grafting.

Methods:

Between March 2004 and March 2013, six patients with Kawasaki disease underwent coronary artery bypass grafting. All patients were male. Their median age was 13.0 years (interquartile range, 7.8–17.8 years) at the timing of coronary artery bypass grafting, and the median age at the onset of Kawasaki disease was 3.3 years (interquartile range, 1.0–7.0 years). Four patients presented with multiple lesions including aneurysms.

Results:

The median follow-up duration was 12.1 years (interquartile range, 9.5–13.1 years), and there were no operative complications or overall mortality. One patient had pre-operative symptoms such as exertional chest pain and dyspnoea on exertion, whereas one patient had ventricular tachyarrhythmia. There was an improvement in subjective symptoms after surgery in two patients. The left internal thoracic artery, right internal thoracic artery, and saphenous vein were used in five (83.3%), one (16.7%), and two (33.3%) cases, respectively. In all six patients, post-operative single-photon emission CT findings showed improved perfusion compared with pre-operative single-photon emission CT. All grafts were patent as confirmed by coronary angiography or CT angiography.

Conclusions:

Coronary artery bypass grafting could be a good surgical option in children with coronary lesions caused by Kawasaki disease in terms of graft patency and myocardial perfusion.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr. Kwak Y and Dr. Kwak JG evenly contributed to this paper as first authors.

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