Outcomes of Total Arterial Coronary Artery Bypass Grafting for Kawasaki Disease in Pediatric Patients: A single center cohort study

Ming Ye; Qiqi Shi; Fang Liu; Na Jiang; Wenbo Zhang; Yaping Mi; Hui Zhong; Yingbei Liu; Qiang Zhao

doi:10.1016/j.athoracsur.2025.05.044

Outcomes of Total Arterial Coronary Artery Bypass Grafting for Kawasaki Disease in Pediatric Patients: A single center cohort study

Ann Thorac Surg. 2025 Jun 21:S0003-4975(25)00542-9. doi: 10.1016/j.athoracsur.2025.05.044. Online ahead of print.

Authors

Ming Ye¹, Qiqi Shi¹, Fang Liu², Na Jiang¹, Wenbo Zhang¹, Yaping Mi¹, Hui Zhong¹, Yingbei Liu¹, Qiang Zhao³

Affiliations

¹ Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, P.R. China.
² Department of Pediatric Cardiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, P.R. China.
³ Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: zq11607@rjh.com.cn.

PMID: 40550319
DOI: 10.1016/j.athoracsur.2025.05.044

Abstract

Background: Coronary artery anomalies resulting from Kawasaki disease in pediatric patients can lead to significant myocardial ischemia, necessitating surgical intervention such as coronary artery bypass grafting (CABG). Total arterial CABG in children is rarely reported.

Methods: A single-center retrospective cohort study was conducted in patients who underwent CABG for Kawasaki Disease-related coronary artery disease between January 2015 and January 2024. Outcomes were assessed through major adverse cardiac events (MACE), graft patency, and cardiac function.

Results: CABG was performed on 46 patients using 72 grafts including 44 internal thoracic arteries and 28 radial arteries. 16 patients (34.8%) received off-pump CABG, with a significantly older median age (P<0.05) and shorter median operation duration (P=0.019) compared to the on-pump CABG group. The outcomes of off-pump group were comparable to on-pump group in terms of perioperative morbidity and postoperative recovery. The median follow-up was 31.5 months (7-108), and all patients survived. MACE occurred in only one patient, with the incidences of freedom from MACE 100%, 96.7%, and 96.7% at 1 year, 3 years and 5 years, respectively. No nonfatal myocardial infarction, angina pectoris or ventricular tachyarrhythmias was recorded in all other patients. The median left ventricular ejection fraction (LVEF) at last follow-up was 0.68 [0.48, 0.78]. All grafts remained patent during follow-up except one with distal anastomosis stenosis.

Conclusions: Total arterial CABG is a safe and effective surgical approach for Kawasaki disease-related coronary artery anomalies in pediatric patients. Off-pump CABG may be a viable option for selected cases. Further research is warranted to establish long-term outcomes and optimal surgical strategies.