Liu Yingbei, Liu Fang, Mi Yaping, Zhang Fan, Ye Ming, Zhang Wenbo
Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China.
Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China.
J Surg Res. 2025 Jul;311:267-272. doi: 10.1016/j.jss.2025.04.044. Epub 2025 May 30.
To investigate the early clinical outcomes of using radial artery (RA) graft for coronary artery bypass graft (CABG) surgery in children with coronary sequelae of Kawasaki disease (KD).
Clinical data of all 26 children (22 male, 4 female) with coronary sequelae of KD who underwent CABG with RA graft at our hospital between March 2016 and September 2023 were retrospectively analyzed. The severity of coronary artery lesions was classified as Va or Vb in all patients.
The median (P25, P75) age of patients was 8.5 (6.0, 11.3) y and the median weight was 33.0 (21.0, 45.3) kg. The mean interval from diagnosis to operation was 5.4 ± 3.7 y. The median postoperative mechanical ventilation time was 6.0 (4.0, 12.3) h. The median intensive care unit stay was 2.0 (2.0, 3.3) d. The median length of postoperative hospital stay was 19.0 (13.0, 29.0) d. Postoperative follow-up time ranged from 0.2 to 5.8 y, and no cardiovascular-related complications occurred. Sixteen patients underwent cardiac catheterization or CT angiography during follow-up. One patient each had anastomotic stenosis in RA and right internal thoracic artery graft, respectively, while myocardial perfusion imaging showed no worsening of myocardial ischemia. There was no significant difference in forearm motor and sensory function between the operated and the contralateral arm; brachial artery angiography showed well-established forearm collateral vessels.
CABG is a safe and effective treatment for KD with severe coronary lesions in children. The RA graft has good early patency without impairing forearm function. Individualized surgical and anticoagulant strategies may help improve the prognosis.
探讨在患有川崎病（KD）冠状动脉后遗症的儿童中，使用桡动脉（RA）移植物进行冠状动脉旁路移植术（CABG）的早期临床结局。
回顾性分析2016年3月至2023年9月期间在我院接受RA移植物CABG手术的所有26例KD冠状动脉后遗症患儿（男22例，女4例）的临床资料。所有患者的冠状动脉病变严重程度均分类为Va或Vb。
患者的中位（P25，P75）年龄为8.5（6.0，11.3）岁，中位体重为33.0（21.0，45.3）kg。从诊断到手术的平均间隔时间为5.4±3.7年。术后机械通气时间的中位数为6.0（4.0，12.3）小时。重症监护病房住院时间的中位数为2.0（2.0，3.3）天。术后住院时间的中位数为19.0（13.0，29.0）天。术后随访时间为0.2至5.8年，未发生心血管相关并发症。16例患者在随访期间接受了心导管检查或CT血管造影。分别有1例患者在RA和右胸廓内动脉移植物中出现吻合口狭窄，而心肌灌注成像显示心肌缺血无恶化。手术侧与对侧手臂的前臂运动和感觉功能无显著差异；肱动脉血管造影显示前臂侧支血管良好。
CABG是治疗儿童KD严重冠状动脉病变的一种安全有效的方法。RA移植物早期通畅性良好，且不损害前臂功能。个体化的手术和抗凝策略可能有助于改善预后。
