Clinical Management
Ming Ye, Professor
Chief of Cardiovascular Surgery, Children's Hospital of Fudan University, China
CHFS, United States
Aim: To investigate the early clinical outcomes of radial artery graft for coronary artery bypass surgery (CABG) in children with coronary artery lesion of KD.
Methods: The clinical data of all KD patients who underwent CABG with radial artery graft in our hospital from March 2016 to September 2023 were retrospectively collected and analyzed. Patients with internal mammary artery (ITA) only were excluded.
Results: Among the 26 patients (mean age 9.0±3.6 years; mean weight 34.5±14.4 kg), 20 patients underwent CABG alone, 4 patients with coronary aneurysm angioplasty at the same time, and another 2 patients with concomitant mitral valve annuloplasty. The average interval from KD diagnosis to CABG in this cohort was 5.4±3.7 years, and the severity of coronary artery lesions were all classified Va or Vb verified by catheterization. The average duration of postoperative mechanical ventilation was 11.5±15.2 hrs and the average length of stay in ICU was 3.7±3.9 days. The median length of postoperative stay was 25.3±22.0 days. No death occurred and no heart failure, arrhythmia, reoperation, or other major adverse cardiovascular event noticed by the last follow up in this cohort. Only one case had delayed wound healing in left forearm, and another with innominate vein thrombosis. Both recovered with non-surgical treatment. The anticoagulation therapy in these patients were individualized. The median postoperative follow-up time was 3.3 (0.2-5.8) years and the average left ventricle ejection fraction was 64.4±7.9%. 16 patients underwent cardiac catheterization or CTA during follow up and 2 of them had mild grafts anastomotic stenosis in RA or ITA separately ( < 50%). The ECG and myocardial perfusion imaging of these two patients did not find worsening myocardial ischemia and no clinical symptom were reported. No significant difference between forearm circumference, strength, fine motor function and sensory function of both arms were noticed. We also conducted brachial artery angiography in 13 patients and noticed that the forearm collateral vessels were well established.
Conclusion: CABG is a safe and effective therapy in the treatment of KD with severe coronary lesions in children with few complications. The radial artery graft has good patency without impairing the function of forearm. Individualized surgical and anticoagulant strategy may improve the prognosis and further study is needed.