The long-term outcome of pediatric coronary artery bypass for patients with severe inflammatory coronary sequelae secondary to Kawasaki disease is unknown, write Soichiro Kitamura, MD, from the National Cardiovascular Center in Osaka, Japan, and colleagues. We describe the long-term outcome of 114 patients after their surgery for KD coronary complications, presently the world’s most common cause of pediatric coronary artery disease.
This case series included of 114 children and adolescents aged 1 to 19 years with median age of 10 years when undergoing CABG. Median follow-up was 19 years (maximum, 25 years). The distal anastomoses mean number per patient was 1.7 ± 0.8. The internal thoracic artery was used most frequently for left anterior descending artery stenosis in all patients except 3, whereas 24 patients had saphenous vein grafting, primarily for lesions affecting other arteries. Multiple angiograms was used for coronary and graft statuses evaluation.
There were no operative or in-hospital deaths. During follow-up 5 deaths occurred were due to cardiac in origin. Survival rates at 20 and 25 years were 95% (95% confidence interval [CI], 88% – 98%). Cardiac event–free rates were 67% at 20 years and 60% at 25 years (95% CI, 46% – 72%). The most prevalent events were percutaneous coronary intervention and reoperation. Although 88 patients (77%) continued to receive medications, all 109 survivors are currently asymptomatic when performing their daily activities.
At 20 years, the overall graft patency rate was 87% (95% CI, 78% – 93%) for internal thoracic artery grafts (n = 154) and 44% (95% CI, 26% – 61%) for saphenous vein grafts (n = 30; P < .001). For non–left anterior descending artery lesions, patency was also significantly better for arterial grafts (87%; 95% CI, 73% – 94%; n = 59) vs saphenous vein grafts (42%; 95% CI, 23% – 60%; n = 27; P = .002).
Although the 25-year survival was excellent after pediatric coronary bypass for Kawasaki disease, the event-free rate declined progressively, the study authors write. This reality mandated continued follow-up. Reinterventions successfully managed most cardiac events.
The study limitations include observational design and possible selection bias.
An internal thoracic artery [ITA] graft was the most favorable for children, the study authors conclude. Pediatric coronary bypass surgery with the use of the ITA should be an established treatment for severe coronary disease due to KD.
Brian W. McCrindle, MD, MPH, from The Hospital for Sick Children, Toronto, Ontario, Canada, reported that many patients with KD will be expected to survive into adulthood.
Successful transition to adult care is an important issue, Dr. McCrindle writes. Outcomes must be tracked seamlessly into adulthood if ongoing concerns about prognosis are to be resolved. In the meantime, advocacy for healthy lifestyle and screening and management of cardiovascular risk factors for all patients is prudent and recommended.
