Midterm outcomes of myocardial revascularization in children

Objective

Pediatric coronary artery bypass grafting is uncommon. Small target vessels and appropriate conduit choice are the main technical challenges.

Methods

Fourteen patients undergoing coronary artery bypass grafting from January 1986 to December 2008 were retrospectively reviewed.

Results

Median age was 10 years (range, 3–15 years); median weight was 36 kg (range, 12–71 kg). Indications included symptoms or evidence of inducible ischemia and angiographically documented coronary stenosis. Diagnoses included Kawasaki disease (5/14), anomalous left coronary artery originating from the pulmonary artery (2/14), previous stent implant (1/14), and metabolic disease (3/14). The remaining 3 patients had coronary stenosis after other cardiac operations. Preoperatively 5 patients (45%) had no symptoms and 9 (64%) had positive stress test. Single-vessel disease was demonstrated in 2 (14%), double-vessel disease in 7 (50%), triple-vessel disease in 1 (7%), and left main coronary artery involvement in 4 (29%). With standard cardiopulmonary bypass, 18 (81%) in situ internal thoracic arteries and 4 (19%) long saphenous veins were grafted. There was 1 early reoperation for graft failure. All patients survived to hospital discharge. Follow-up angiography was performed in 5 patients (36%; median, 2 years; range, 1 day–10 years), and 1 (7%) required late balloon dilatation. Median follow-up was 3.3 years (1 month–10 years), and 12 patients had no symptoms. There was 1 late death of noncardiac cause.

Conclusions

Pediatric coronary artery bypass grafting can be performed for a wide range of indications. Midterm results are excellent. Preoperative stress testing can detect silent myocardial ischemia.

CTSNet classification: 23.1

Abbreviations and Acronyms: ALCAPA, anomalous left coronary artery from pulmonary artery, CABG, coronary artery bypass grafting, ITA, internal thoracic artery, LAD, left anterior descending coronary artery, PTCA, percutaneous transluminal coronary angioplasty, RCA, right coronary artery, SVG, saphenous vein graft