Outcomes of Total Arterial Coronary Artery Bypass Grafting for Kawasaki Disease in Pediatric Patients: A Single-Center Cohort Study.

Abstract

Coronary artery anomalies resulting from Kawasaki disease in pediatric patients can lead to significant myocardial ischemia, necessitating surgical intervention such as coronary artery bypass grafting (CABG). Total arterial CABG in children is rarely reported. A single-center retrospective cohort study was conducted in patients who underwent CABG for Kawasaki disease-related coronary artery disease between January 2015 and January 2024. Outcomes were assessed through major adverse cardiac events, graft patency, and cardiac function. CABG was performed on 46 patients using 72 grafts including 44 internal thoracic arteries and 28 radial arteries. Sixteen patients (34.8%) received off-pump CABG, with a significantly older median age (P < .05) and shorter median operation duration (P = .019) compared with the on-pump CABG group. The outcomes of off-pump group were comparable to on-pump group in terms of perioperative morbidity and postoperative recovery. The median follow-up was 31.5 (range, 7-108) months, and all patients survived. Major adverse cardiac events occurred in only 1 patient, with the incidences of freedom from major adverse cardiac events 100%, 96.7%, and 96.7% at 1 year, 3 years, and 5 years, respectively. No nonfatal myocardial infarction, angina pectoris, or ventricular tachyarrhythmias was recorded in all other patients. The median left ventricular ejection fraction at last follow-up was 0.68 (range, 0.48-0.78). All grafts remained patent during follow-up except 1 with distal anastomosis stenosis. Total arterial CABG is a safe and effective surgical approach for Kawasaki disease-related coronary artery anomalies in pediatric patients. Off-pump CABG may be a viable option for selected cases. Further research is warranted to establish long-term outcomes and optimal surgical strategies.