title: Pediatric coronary artery revascularization: a European multicenter study.
abstract: BACKGROUND
  We sought to evaluate the hospital and midterm results of different surgical revascularization techniques in pediatric patients within the European Congenital Heart Surgeons Association.
  
  
  METHODS
  From 1973 to 2011, 80 patients from 13 European Congenital Heart Surgeons Association centers underwent 65 pediatric coronary artery bypass grafting (PCABG) and 27 other coronary artery procedures (OCAP; 12 patients had combined PCABG and other coronary artery procedures). Excluded were patients with Kawasaki disease. Median age at the time of coronary procedure was 2.3 years (range, 2 days to 16.9 years); 33 patients (41.2%) were younger then 12 months. An emergency procedure was necessary in 34 patients (42.5%).
  
  
  RESULTS
  Twelve patients (15%) died in the hospital; age at surgery (p=0.02) and the need for an emergent procedure (p=0.0004) were related to hospital mortality. Median follow-up time was 7.6 years (range, 0.9 to 23 years). There were 3 late cardiac deaths, all after a median time of 4 years (range, 9 months to 8.8 years) after PCABG. Fourteen patients (20.5%) presented with symptoms, including congestive heart failure (n=10) and angina (n=4), that were significantly associated with a low ejection fraction (p<0.001) and the presence of moderate or severe mitral valve regurgitation (p=0.0003). Six patients underwent a reintervention for impaired myocardial perfusion; all of them had a stenotic or atretic PCABG (p=0.001), and the majority were symptomatic (5 of 6 patients; 83.3%; p=0.001).
  
  
  CONCLUSIONS
  Both PCABG and other coronary artery procedures are suitable surgical options in pediatric patients with impaired myocardial perfusion, which increases operative and midterm survival. Such population of patients needs to be followed for life to prevent and treat any possible cause of further myocardial ischemia.
authors.affiliation: Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Italy.
authors.forename: Vladimiro L
authors.initials: VL
authors.lastname: Vida
authors.forename: Gianluca
authors.initials: G
authors.lastname: Torregrossa
authors.forename: Marco
authors.initials: M
authors.lastname: De Franceschi
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Padalino
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
authors.forename: Hakan
authors.initials: H
authors.lastname: Berggren
authors.forename: Sertaç
authors.initials: S
authors.lastname: Çiçek
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
authors.forename: José
authors.initials: J
authors.lastname: Fragata
authors.forename: Tom N
authors.initials: TN
authors.lastname: Hoel
authors.forename: Jurgen
authors.initials: J
authors.lastname: Horer
authors.forename: Viktor
authors.initials: V
authors.lastname: Hraska
authors.forename: Martin
authors.initials: M
authors.lastname: Kostolny
authors.forename: Harald
authors.initials: H
authors.lastname: Lindberg
authors.forename: Christoph
authors.initials: C
authors.lastname: Mueller
authors.forename: Rene
authors.initials: R
authors.lastname: Pretre
authors.forename: Barbara
authors.initials: B
authors.lastname: Rosser
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.forename: Simone
authors.initials: S
authors.lastname: Speggiorin
authors.forename: Tomas
authors.initials: T
authors.lastname: Tlaskal
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
mesh_terms: D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality*; D003324:Coronary Artery Disease / Q000151:congenital / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012955:Societies, Medical; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 20