Results and indications of coronary artery bypass graft operation for coronary artery lesion after Kawasaki disease

  • Masanori Abe, Nippon Medical School, Japan
  • Ryuji Fukazawa, Nippon Medical School, Japan
  • Ei Ikegami, Nippon Medical School, Japan
  • Mitsuhiro Kamisago, Nippon Medical School, Japan
  • Yasuhiro Katsube, Nippon Medical School, Japan
  • Shunichi Ogawa, Nippon Medical School, Japan
  • Masami Ochi, Nippon Medical School, Japan

    • Background:
    Coronary artery lesion (CAL) in children caused by Kawasaki disease (KD) can lead to serious complications including myocardial ischemia and infarction. We tested whether coronary artery Bypass Graft operation (CABG) could be effective for KD patients with CAL.
    Methods:
    Thirty cases with 50 branches had undergone CABG. The age at CABGs was 12.1 ± 8.1y. For 47 LCA branches and 3 RCA branches, CABGs were performed. The details are next; Y type anastomosis using RITA for 1 case and 2 branches, sequential anastomosis between LITA to LAD and D1 for six cases and 12 branches, anastomosis of GEA graft for 2 cases, anastomosis of GEA free graft for 1 case. CALs are in the followings:1) 18 cases had Giant Aneurysms with stenosis or occlusion, 2) four had uncontrollable thrombus in Giant aneurysms, 3) four had Giant Aneurysms without stenosis, 4) 2 had with stenosis without PCI indication. All cases showed myocardial ischemia.
    Results:
    All 30 cases are survived without exercise limitation and are classified under NYHA1. Coronary angiography showed that 46 of 50 branches were patent without anastomosis stenosis. But, 3 branches in Y type graft and 1 branch anastomosised by GEA were occluded. According to growth, diameter and length in bypass graft were grown.
    Conclusions:
    We recommend the following methods of CABG in KD patients, especially infant and young child. 1. On-pump, 2. End to side anastomosis of one graft using LITA or RITA to one branch, 3. Sequential anastomosis could be allowed in more than young-adult.