Arnaz Ahmet, Sarioglu Tayyar, Yalcinbas Yusuf, Erek Ersin, Turkoz Riza, Oktay Ayla, Saygili Arda, Altun Dilek, Sarioglu Ayse
Department of Cardiovascular Surgery, School of Medicine, Acibadem University, Istanbul, Turkey.
Department of Cardiovascular Surgery, Acibadem Bakirkoy Hospital, Istanbul, Turkey.
J Card Surg. 2018 Jan;33(1):29-34. doi: 10.1111/jocs.13510. Epub 2018 Jan 7.
We present our clinical experience with coronary artery bypass grafting (CABG) in children.
Ten children who underwent CABG between July 1995 and August 2017 were retrospectively analyzed. Data including congenital cardiac malformations, previous surgical procedures, age and sex, type of coronary complications, ischemic events preceding surgery, and ventricular function before and after CABG were recorded.
The study population consisted of five males and five females with a median age of 2.5 years (range, 88 days to 15 years). Eight internal mammary arteries (IMAs) and two saphenous veins were used for grafting. Indications for bypass grafting were coronary artery (CA) complications related to the post-arterial switch operation in six, CA complications during the Ross procedure in two, and an iatrogenic CA injury during complete repair of tetralogy of Fallot with abnormal CA, crossing the right ventricular outflow tract in two patients. Six of the grafts were performed as rescue procedures. Three patients died during hospitalization. The mean follow-up time was 6.8 years (range, 3 months to 18 years). Anastomoses were evaluated by coronary angiography in four patients, and were all patent. Echocardiography revealed normal myocardial function in all patients.
Our study suggests that the IMA should be the graft of choice in children due to its growth potential and long-term patency.
我们介绍了儿童冠状动脉旁路移植术（CABG）的临床经验。
回顾性分析了1995年7月至2017年8月期间接受CABG的10名儿童。记录的数据包括先天性心脏畸形、既往手术史、年龄和性别、冠状动脉并发症类型、手术前的缺血事件以及CABG前后的心室功能。
研究人群包括5名男性和5名女性，中位年龄为2.5岁（范围为88天至15岁）。使用了8条乳内动脉（IMA）和2条大隐静脉进行移植。旁路移植的指征包括6例与动脉调转术后相关的冠状动脉（CA）并发症、2例Ross手术期间的CA并发症以及2例法洛四联症完全修复过程中因CA异常穿过右心室流出道导致的医源性CA损伤。其中6例移植是作为挽救手术进行的。3例患者在住院期间死亡。平均随访时间为6.8年（范围为3个月至18年）。4例患者通过冠状动脉造影评估吻合口，均通畅。超声心动图显示所有患者心肌功能正常。
我们的研究表明，由于IMA的生长潜力和长期通畅性，它应成为儿童移植的首选。
