Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2018 Sep 17;33(42):e267. doi: 10.3346/jkms.2018.33.e267. eCollection 2018 Oct 15.
This study aimed to review the long-term clinical outcomes and graft patency of coronary artery bypass grafting (CABG) using arterial grafts in patients with Kawasaki disease (KD) affecting the coronary artery.
Twenty patients with KD who underwent CABG from January 2002 to June 2014 were enrolled. There were 4 male (20%) and 16 female (80%) patients with ages at operation ranging from 2 to 42 years (median, 17.5 years). Our routine operative strategy was off-pump CABG with arterial grafts. The mean follow-up duration was 59.5 ± 48.5 months (range, 1-159 months). Coronary angiogram or computed tomography angiogram was used to evaluate graft patency in 16 patients (80%).
All patients survived CABG without late mortality. Left internal thoracic arteries were used in 19 patients, while right internal thoracic arteries were used in 10 patients. Right gastroepiploic arteries were used in 3 patients, and a saphenous vein graft (SVG) was used in 1 patient. Among the 20 patients, 2 patients underwent coronary reintervention with balloon angioplasty because of graft failure. Two patients underwent coronary reintervention because of new obstructive lesions that were not significant at the time of the initial operation. Patency rates at 5 and 10 years were 94% and 87%, respectively. The rate of freedom from coronary reintervention at 10 years was 82%.
Off-pump CABG with mainly arterial graft revascularization may be considered a good surgical option for coronary lesions caused by KD.
本研究旨在回顾川崎病（KD）导致冠状动脉病变患者接受冠状动脉旁路移植术（CABG）使用动脉移植物的长期临床结果和移植物通畅率。
2002 年 1 月至 2014 年 6 月期间，我们共纳入 20 名接受 CABG 的 KD 患者。其中男 4 例（20%），女 16 例（80%），手术时年龄 2 至 42 岁（中位数 17.5 岁）。我们的常规手术策略是使用动脉移植物的非体外循环 CABG。平均随访时间为 59.5 ± 48.5 个月（范围 1-159 个月）。16 例患者（80%）采用冠状动脉造影或计算机断层血管造影评估移植物通畅情况。
所有患者均在 CABG 后存活，无晚期死亡。19 例患者使用左内乳动脉，10 例患者使用右内乳动脉。3 例患者使用右胃网膜动脉，1 例患者使用大隐静脉移植物（SVG）。20 例患者中，2 例因移植物失功而行球囊血管成形术冠状动脉再介入治疗，2 例因初始手术时非显著新的阻塞性病变而行冠状动脉再介入治疗。5 年和 10 年的通畅率分别为 94%和 87%。10 年时免于冠状动脉再介入治疗的比率为 82%。
对于由 KD 引起的冠状动脉病变，非体外循环 CABG 联合主要动脉移植物血运重建可能是一种较好的手术选择。
