Pediatric coronary artery bypass for Kawasaki congenital, post arterial switch, and iatrogenic lesions.
BACKGROUND
Pediatric coronary artery bypass (PCAB) has been recently employed for expanding indications to treat acquired, congenital, post arterial switch, and other iatrogenic pediatric coronary artery problems.


METHODS
Between 1987 and 1998, 3 infants and 13 children (n = 16, mean age 6.1 years, range 2 months-18 years) underwent one or more internal thoracic artery (ITA) to coronary artery (CA) bypass grafts for Kawasaki disease (n = 4), congenital lesions (n = 3), post arterial switch (n = 4), and other iatrogenic obstructions (n = 5). Proximal left main CA arterioplasty was performed concurrently with ITA-CA bypass in 4 patients.


RESULTS
Survival is 93.8%. All bypass grafts in surviving patients are patent 2 months-11 years postoperation. The 11 elective patients are well (NYHA I-II). The 5 emergent operations were performed in 2 infants and 3 adolescents who had poor ventricular function prior to ITA-CA bypass due to iatrogenic injuries in 3, congenital critical left main stenosis in 1, and intraoperative iatrogenic coronary injury in 1. The 3 adolescents fared worse, resulting in death in the first, cardiac transplantation in the second, and full recovery in the third. The 2 infants have steadily improving ventricular function.


CONCLUSIONS
ITA-CA bypass can be successfully performed in infants and children for expanding elective and life-saving indications with excellent results. Poor preoperative ventricular function often persists, especially in those older children with iatrogenic injuries, and may result in death or cardiac transplantation.
Mavroudis
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Department of Cardiovascular Surgery, Children's Memorial Hospital, Chicago, Illinois 60614, USA. c-mavroudis@nwu.edu
Backer
C L
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Duffy
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Pahl
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Wax
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DF
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*