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Long-term survival “excellent” after coronary bypass surgery for Kawasaki disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Pediatric coronary bypass surgery using an internal thoracic artery graft is effective treatment for children and adolescents with severe coronary sequelae secondary to Kawasaki disease, physicians in Japan report in the July 7 issue of Circulation.

In their follow-up study of more than 100 patients, 25-year survival was 95%, although late complications requiring reinterventions were common. “In fact,” Dr. Soichiro Kitamura, at the National Cardiovascular Center in Osaka, and co-authors note, “80% of survivors were enjoying unlimited daily activities, including sports,” and all were symptom-free.

Dr. Kitamura’s team describes the outcomes for 114 patients (range 1 to 19 years of age, median 10 years; 25% female). Surgery took place at a median of 6 years after acute illness, and median follow-up was 19 years (maximum 25 years).

The 5 deaths that occurred between 3 months and 12 years after the operation were all cardiac in origin; death was sudden in 3 cases. The authors note all 5 patients had a history of previous MI and frequent ventricular arrhythmias, and that postoperative ejection fraction did not exceed 0.5.

The cardiac event-free rates were 87% at 5 years, 81% at 10 years, 67% at 20 years and 60% at 25 years. “Postoperative interventions… were most common as a result of graft anastomotic stenosis (early event), graft closure (midterm), new obstructive lesions and vein graft atherosclerosis (late events),” Dr. Kitamura and his associates report.

They recommend using the internal thoracic artery for coronary revascularization, because it continues to grow as the child does, and has enhanced endothelial function.

“Outcomes must be tracked seamlessly into adulthood if ongoing concerns about prognosis are to be resolved,” Dr. Brian W. McCrindle, of the Hospital for Sick Children, Toronto, writes in a related editorial.

Circulation 2009;120.