Myocardial revascularization in infants and children by means of coronary artery proximal patch arterioplasty or bypass grafting: A single-institution experience

Objective

We sought to evaluate midterm functional and anatomic results after coronary artery surgical arterioplasty or bypass grafting in infants and children.

Methods

Data concerning all consecutive patients operated on for myocardial revascularization in our institution between 1992 and 2004 were retrospectively analyzed.

Results

Twenty-five patients (mean age, 5.3 years) underwent surgical arterioplasty of a main coronary trunk, and this was for coronary obstruction after the arterial switch operation in 19 patients. Eight patients (mean age, 8.0 years) underwent a coronary bypass, and this was for postoperative coronary obstruction in all of them. One patient died 4 days after arterioplasty because of cardiogenic shock. One patient died suddenly 3.5 months after bypass from an unknown cause. All other patients were alive after a mean follow-up of 3.4 years after arterioplasty and 4.4 years after bypass. Among the 3 patients in whom the surgical enlargement of the left main trunk was extended to the left anterior descending coronary artery, 2 presented a restenosis of this artery and necessitated a coronary bypass 2.6 and 5.7 years, respectively, after arterioplasty. Among patients who had a postoperative angiogram, 17 (89%) of 19 after arterioplasty and 3 (50%) of 6 after bypass showed a good result. A internal thoracic artery graft was occluded, another one showed a complete string sign, and, finally, a patient presented with a tight stenosis of the bypass distal anastomosis. Eighteen (72%) patients after arterioplasty and 5 (63%) after bypass remained symptom free at last follow-up.

Conclusions

Provided that the left main coronary artery bifurcation was not involved in the stenotic process, surgical arterioplasty of the main coronary trunks led to good functional and anatomic midterm results. On the other hand, variable indications and poorer preoperative cardiac conditions might have contributed to the disappointing results observed after coronary bypass.

Abbreviations and Acronyms: ASO, arterial switch operation, CABG, coronary artery bypass grafting, CAPPA, coronary artery proximal patch arterioplasty, CPB, cardiopulmonary bypass, ICU, intensive care unit, ITA, internal thoracic artery, LAD, left anterior descending coronary artery, LITA, left internal thoracic artery, LMCA, left main coronary artery, PA, pulmonary artery, RCA, right coronary artery, RV, right ventricle

CTSNet classification: 20, 23