Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Ann Thorac Surg. 2019 Sep;108(3):799-805. doi: 10.1016/j.athoracsur.2019.03.079. Epub 2019 Apr 27.
Although coronary artery bypass grafting (CABG) is the preferred choice for advanced Kawasaki disease (KD)-associated coronary artery disease, graft design such as number of grafts or type of conduits has not been fully established. We reviewed a series of patients who underwent single or multiple CABG for coronary artery disease of KD sequelae to investigate the optimum revascularization strategy.
We enrolled a consecutive series of 102 CABG surgeries in 92 patients during the last 36 years. Mean patient age at CABG was 14.9 ± 10.4 years. Internal thoracic artery, radial artery, and gastroepiploic artery were used in 100 (98%), 18 (15%), and 4 (4%) cases, respectively. Patients were divided into 2 groups by single (n = 53) or multiple (n = 49) CABG.
Actuarial survival was 93% in single CABG and 91% in multiple CABG at 30 years (P = .71). There was no in-hospital mortality, but 6 deaths occurred long term, with no significant difference between the groups. Freedom from cardiac events was 45.2% in single CABG and 68.5% in multiple CABG at 25 years (P = .228), and reintervention to the left anterior descending (LAD) artery territory was the most common event. Graft patency of the internal thoracic artery-LAD artery graft was 81% in single CABG and 85% in multiple CABG at 25 years. Patency of the radial artery in the non-LAD artery territories was significantly greater than that of the saphenous vein graft at 10 years (91% vs 46%, P = .013).
Multiple CABG using arterial conduits is feasible, safe, and therapeutically effective long term for patients with advanced KD-associated coronary artery disease.
尽管冠状动脉旁路移植术（CABG）是治疗晚期川崎病（KD）相关冠状动脉疾病的首选方法，但移植物设计（如移植物数量或移植物类型）尚未完全确定。我们回顾了一系列因 KD 后遗症导致冠状动脉疾病而接受单支或多支 CABG 的患者，以研究最佳血运重建策略。
我们回顾性分析了过去 36 年中 92 例患者的 102 例 CABG 手术。CABG 时患者的平均年龄为 14.9±10.4 岁。100 例（98%）使用内乳动脉、桡动脉和胃网膜动脉，18 例（15%）和 4 例（4%）分别使用桡动脉和胃网膜动脉。根据单支（n=53）或多支（n=49）CABG 将患者分为两组。
单支 CABG 的 30 年生存率为 93%，多支 CABG 为 91%（P=0.71）。无院内死亡，但长期死亡 6 例，两组间无显著差异。单支 CABG 的无心脏事件生存率为 45.2%，多支 CABG 为 68.5%（P=0.228），左前降支（LAD）区域的再介入是最常见的事件。单支 CABG 内乳动脉-LAD 动脉移植物通畅率为 81%，多支 CABG 为 85%（P=0.25）。非 LAD 区域的桡动脉通畅率明显高于大隐静脉移植物（10 年时为 91% vs. 46%，P=0.013）。
对于晚期 KD 相关冠状动脉疾病患者，多支 CABG 使用动脉移植物是可行的、安全的，且长期治疗效果良好。
