Abstract 2956: Twenty Year Prognosis of Coronary Artery Bypass Grafting for Coronary Stenosis caused by Kawasaki Disease
(Backgrounds) The long-term prognosis of coronary artery bypass grafting (CABG) for coronary stenosis caused by Kawasaki disease remains unknown.
(Methods) Seventy-nine (58 male 21 female) patients underwent this operation; their age at operation ranged from 1 to 31 years (median 8 years). The internal thoracic artery as graft was used in 77 patients, and the saphenous vein was 14 patients. The mean number of grafts was 1.6 per patient. The interval from operation to latest angiogram as confirmed graft patency and the left ventricular ejection fraction (LVEF) ranged from 7 days to 26 years (median 6 years), and the postoperative follow-up period ranged from 3 months to 26 years (median 10 years). Cardiac events (CE) after operation were investigated retrospectively. Death, acute myocardial infarction, ventricular tachycardia (VT) and syncope were included in CE. For analysis of prognosis, patients were divided into two groups based on graft patency. Patent group included the patients who had had patent graft more than one in this study. Further, patients in graft patent group were divided into two groups based on the LVEF of 50%, and myocardial ischemia and non-sustained VT (NSVT) were investigated in two groups. CE free rates were analyzed by Kaplan-Meier method. Differences were assessed by the Cox-Mantel test.
(Results) The 25-year survival rate in this study was 95% (n=79). The CE free rate at 20 years after operation in patent group was 98% (n=67), while that in occluded group was 60% (n=12) (P<0.05). The CE free rate was significantly high in patent group. In patent group, the 20-year CE free rate in the LVEF less than 50% was 88% (n=14), and it was significantly lower than the 100% (n=53), seen in the LVEF more than or equal to 50% (P<0.01). The incidence of NSVT in the LVEF less than 50% was 36 %, and it was significantly higher than that in the 2%, seen in LVEF more than or equal to 50% (P<0.01). The incidence of myocardial ischemia in the LVEF less than 50% was 79%, and it was significantly higher than that in the 11%, seen in LVEF more than or equal to 50% (P<0.01).
(Conclusions) The prognosis in patients after CABG was determined by graft patency and the LVEF. If both factors are well, the prognosis will be good. Otherwise, NSVT and myocardial damage influenced long-term prognosis.