Tsuda Etsuko, Kumamaru Hiraku, Kitagawa Tetsuya, Kinukawa Naoko, Mitani Yoshihide, Motomura Noboru
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita-shi, Osaka, Japan.
Japan Cardiovascular Surgery Database Organization.
JTCVS Open. 2024 Oct 26;24:227-238. doi: 10.1016/j.xjon.2024.10.016. eCollection 2025 Apr.
The study objective was to know how the results of patients who underwent coronary artery bypass grafting for coronary arterial lesions caused by Kawasaki disease have changed in the past half-century after the first report of Kawasaki disease.
We investigated the national results of coronary artery bypass grafting in patients with Kawasaki disease who underwent the procedures between 2008 and 2019 from the Japan Cardiovascular Surgery Database Organization. The prevalence and outcome of patients with coronary artery bypass grafting were clarified. The factors that affected the condition upon discharge were analyzed. Furthermore, the outcomes of the patients in the late period after discharge were surveyed by questionnaires in 2021.
A total of 343 patients were identified. Coronary artery bypass grafting after Kawasaki disease has been performed in approximately 40 patients per year recently. There were 264 male patients (77.0%) and 79 female patients (23.0%). The median age at the time of the operation was 39 years (5th-95th percentile, 13-72). The 30-day-operative mortality was 0.9%. Of the 183 patients (53.8%) with the quwtionaires after discharge, 176 survived (96.2%), and 7 died (3.8%). The 10-year survival rate was 94% (95% CI, 87-97%) (n = 183). The 5-year survivals depended on the preoperative left ventricular ejection fraction, which was 72% (95% CI, 13-96) (n = 9) for the poor group (left ventricular ejection fraction <30%), 98% (95% CI, 87-100) (n = 104) for the preserved group (≥60%), and 94% (95% CI, 81-98) (n = 70) for the intermediate group (≥30% but <60%) ( < .05).
A half-century after the first report of Kawasaki disease, the ages of the patients who undergo coronary artery bypass grafting in this population have changed from children to young adults. Although the preoperative left ventricular function affected the long-term outcome, the operative results were good.
本研究的目的是了解在川崎病首次报告后的过去半个世纪里，因川崎病导致冠状动脉病变而接受冠状动脉旁路移植术的患者的结果有何变化。
我们从日本心血管外科数据库组织调查了2008年至2019年间接受手术的川崎病患者冠状动脉旁路移植术的全国结果。明确了冠状动脉旁路移植术患者的患病率和结局。分析了影响出院时病情的因素。此外，在2021年通过问卷调查对出院后期患者的结局进行了调查。
共确定了343例患者。近年来，每年约有40例患者接受川崎病后的冠状动脉旁路移植术。男性患者264例（77.0%），女性患者79例（23.0%）。手术时的中位年龄为39岁（第5-95百分位数，13-72岁）。30天手术死亡率为0.9%。在183例出院后接受问卷调查的患者中（53.8%），176例存活（96.2%），7例死亡（3.8%）。10年生存率为94%（95%CI，87-97%）（n = 183）。5年生存率取决于术前左心室射血分数，差的组（左心室射血分数<30%）为72%（95%CI，13-96）（n = 9），保留组（≥60%）为98%（95%CI，87-100）（n = 104），中间组（≥30%但<60%）为94%（95%CI，81-98）（n = 70）（P<0.05）。
在川崎病首次报告后的半个世纪里，该人群中接受冠状动脉旁路移植术的患者年龄已从儿童变为年轻成年人。虽然术前左心室功能影响长期结局，但手术结果良好。
