Mid-term results of coronary artery bypass grafting for Kawasaki disease with coronary aneurysm in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Qiupeng ^1,2 , LUO Kai ¹ , PAN Yanjun ¹ , ZHENG Jinghao ¹ , SHEN Jie ¹ ,  ZHU Zhongqun ¹

1. The Heart Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P. R. China;
2. Department of Cardiothoracic Surgery, Jiujiang Maternal and Children’s Health Care Hospital, Jiujiang, 332100, Jiangxi, P. R. China;

Corresponding author：

ZHU Zhongqun, Email: zzqheart2022@163.com

Keywords：

Kawasaki disease; coronary artery aneurysm; coronary artery bypass grafting; internal thoracic artery

DOI：

10.7507/1007-4848.202506013

Video：

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Objective To analyze the timing and mid-term prognosis of bypass surgery for children with Kawasaki disease complicated with coronary artery aneurysms. Methods A retrospective analysis was conducted on the clinical data of children with Kawasaki disease complicated with coronary artery aneurysms who underwent coronary artery bypass grafting at Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from March 2018 to December 2023. Results Finally, 20 pediatric patients were enrolled, including 16 males and 4 females, with a median age of 118 (74, 140) months. All patients who failed drug treatment and had progressive coronary artery dilation with thrombosis underwent bypass surgery, including 14 patients with cardiac arrest and 6 patients without cardiac arrest. One patient died of severe left heart failure. The median follow-up of 19 surviving children was 34 (16, 61) months, and 84.2% of them had electrocardiogram recovery. The coronary artery diameter decreased from (16.2±9.2) mm to (8.2±2.7) mm, and the left ventricular ejection fraction increased from (58.2±8.6)% to (63.8±7.0)%. The 89.4% (17/19) of the patients’ vessels were unobstructed, and 94.7% of the heart function recovered to grade Ⅰ/Ⅱ. Conclusion Coronary artery bypass grafting is safe and effective for treating Kawasaki disease coronary artery aneurysms in children, with a good mid-term prognosis.

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2.	Newburger JW, Takahashi M, Burns JC. Kawasaki disease. J Am Coll Cardiol, 2016, 67(14): 1738-1749.
3.	Tsuda E, Hamaoka K, Suzuki H, et al. A survey of the 3-decade outcome for patients with giant aneurysms caused by Kawasaki disease. Am Heart J, 2014, 167(2): 249-258.
4.	Shulman ST, Rowley AH. Kawasaki disease: insights into pathogenesis and approaches to treatment. Nat Rev Rheumatol, 2015, 11(8): 475-482.
5.	McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation, 2017, 135(17): e927-e999.
6.	Muta H, Ishii M. Percutaneous coronary intervention versus coronary artery bypass grafting for stenotic lesions after Kawasaki disease. J Pediatr, 2010, 157(1): 120-126.
7.	Dionne A, Bakloul M, Manlhiot C, et al. Coronary artery bypass grafting and percutaneous coronary intervention after Kawasaki disease: the pediatric canadian series. Pediatr Cardiol, 2017, 38(1): 36-43.
8.	Kitamura S, Tsuda E, Kobayashi J, et al. Twenty-five-year outcome of pediatric coronary artery bypass surgery for Kawasaki disease. Circulation, 2009, 120(1): 60-68.
9.	Viola N, Alghamdi AA, Al-Radi OO, et al. Midterm outcomes of myocardial revascularization in children. J Thorac Cardiovasc Surg, 2010, 139(2): 333-338.
10.	Newburger JW, Fulton DR. Coronary revascularization in patients with Kawasaki disease. J Pediatr, 2010, 157(1): 8-10.
11.	Kitamura S, Kawashima Y, Fujita T, et al. Aortocoronary bypass grafting in a child with coronary artery obstruction due to mucocutaneous lymphnode syndrome: report of a case. Circulation, 1976, 53(6): 1035-1040.
12.	Kitamura S, Mizuguchi K, Kobayashi S, et al. Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary bypass surgery. New evidence for a "live" conduit. Circulation, 1988, 78(1): 129-139.
13.	Kitamura S, Tsuda E, Kobayashi J, et al. Twenty-five-year outcome of pediatric coronary artery bypass surgery for Kawasaki disease. Circulation, 2009, 120(1): 60-68.
14.	罗凯, 郑景浩, 何晓敏, 等. 儿童期川崎病并发冠状动脉瘤外科治疗初步探究. 中华小儿外科杂志, 2021, 42(12): 1066-1071.Luo K, Zheng JH, He XM, et al. Preliminary study on surgical treatment for children complicated with Kawasaki disease and coronary artery aneurysm. Chin J Pediatr Surg, 2021, 42(12): 1066-1071.
15.	罗凯, 郑景浩, 祝忠群, 等. 冠状动脉旁路移植术治疗幼儿川崎病1例. 中华心血管病杂志, 2023, 51(7): 772-775.Luo K, Zheng JH, Zhu ZQ, et al. Coronary artery bypass grafting surgery for treatment of an infant with Kawasaki disease: a case report. Chin J Cardiovasc Dis, 2023, 51(7): 772-775.

1. Ayusawa M, Namiki H, Abe Y, et al. Sudden death in patients with a history of Kawasaki disease under school supervision. Children (Basel), 2022, 9(10): 1593.
2. Newburger JW, Takahashi M, Burns JC. Kawasaki disease. J Am Coll Cardiol, 2016, 67(14): 1738-1749.
3. Tsuda E, Hamaoka K, Suzuki H, et al. A survey of the 3-decade outcome for patients with giant aneurysms caused by Kawasaki disease. Am Heart J, 2014, 167(2): 249-258.
4. Shulman ST, Rowley AH. Kawasaki disease: insights into pathogenesis and approaches to treatment. Nat Rev Rheumatol, 2015, 11(8): 475-482.
5. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation, 2017, 135(17): e927-e999.
6. Muta H, Ishii M. Percutaneous coronary intervention versus coronary artery bypass grafting for stenotic lesions after Kawasaki disease. J Pediatr, 2010, 157(1): 120-126.
7. Dionne A, Bakloul M, Manlhiot C, et al. Coronary artery bypass grafting and percutaneous coronary intervention after Kawasaki disease: the pediatric canadian series. Pediatr Cardiol, 2017, 38(1): 36-43.
8. Kitamura S, Tsuda E, Kobayashi J, et al. Twenty-five-year outcome of pediatric coronary artery bypass surgery for Kawasaki disease. Circulation, 2009, 120(1): 60-68.
9. Viola N, Alghamdi AA, Al-Radi OO, et al. Midterm outcomes of myocardial revascularization in children. J Thorac Cardiovasc Surg, 2010, 139(2): 333-338.
10. Newburger JW, Fulton DR. Coronary revascularization in patients with Kawasaki disease. J Pediatr, 2010, 157(1): 8-10.
11. Kitamura S, Kawashima Y, Fujita T, et al. Aortocoronary bypass grafting in a child with coronary artery obstruction due to mucocutaneous lymphnode syndrome: report of a case. Circulation, 1976, 53(6): 1035-1040.
12. Kitamura S, Mizuguchi K, Kobayashi S, et al. Excellent patency and growth potential of internal mammary artery grafts in pediatric coronary bypass surgery. New evidence for a "live" conduit. Circulation, 1988, 78(1): 129-139.
13. Kitamura S, Tsuda E, Kobayashi J, et al. Twenty-five-year outcome of pediatric coronary artery bypass surgery for Kawasaki disease. Circulation, 2009, 120(1): 60-68.
14. 罗凯, 郑景浩, 何晓敏, 等. 儿童期川崎病并发冠状动脉瘤外科治疗初步探究. 中华小儿外科杂志, 2021, 42(12): 1066-1071.Luo K, Zheng JH, He XM, et al. Preliminary study on surgical treatment for children complicated with Kawasaki disease and coronary artery aneurysm. Chin J Pediatr Surg, 2021, 42(12): 1066-1071.
15. 罗凯, 郑景浩, 祝忠群, 等. 冠状动脉旁路移植术治疗幼儿川崎病1例. 中华心血管病杂志, 2023, 51(7): 772-775.Luo K, Zheng JH, Zhu ZQ, et al. Coronary artery bypass grafting surgery for treatment of an infant with Kawasaki disease: a case report. Chin J Cardiovasc Dis, 2023, 51(7): 772-775.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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