Abstract 13351: Surgical Coronary Revascularization in Pediatric Patients: A European Congenital Heart Surgerons Association Multicentric Study
Background: We sought to evaluate hospital and follow-up outcomes of patients requiring myocardial revascularization in the pediatric age group.
Methods: From 1969 to 2011, 88 patients from 13 ECHSA centers underwent 71 pediatric coronary artery bypass grafting (PCABG) and 35 coronary artery (CA) procedures. Excluded were patients with Kawasaky disease. Transposition of the great arteries and anomalous origin of the left coronary artery from the pulmonary artery were the most frequent diagnoses (45% and 22% respectively). An abnormal coronary artery pattern was present in 68 patients (77%). Median age at myocardial revascularization was 2.8 years (range 2 days-18 years). Thirty-seven patients (42%) were younger then 12 months. Emergency PCABG was necessary in 39 patients (45%), following a iatrogenic CA lesion. Forty-nine patients underwent a delayed CA procedure for myocardial revascularization, after a median time of 4.5 years (range 4 days-18 years). Graft material included: left internal mammary artery (n=50), right internal mammary artery (n=12) and saphenous vein (n=9). A left main coronary artery patch enlargement was the most frequent CA procedure (n=16,45%).
Results: 14 patients (16%) died in hospital. Seventeen patients required a postoperative mechanical circulatory support for a median time of 7 days (range 1-19 days). Median follow-up time was 6.5 years (range 0.9-23 years). Five patients died late after a median time of 4 years (range 9 months-8.8 years) from CA procedures. Fifteen of 69 patients (21%) presented with symptoms, including congestive heart failure (n=10) and angina (n=5). Forty-nine of the survivors (49/69,63%) underwent a control coronary angiography: the PACBG was patent in 25 patients, stenotic in 11 and occluded in 5. The CA following other coronary procedures was patent in 7 patients and stenotic in 1. Six symptomatic patients underwent a re-intervention for impaired myocardial perfusion, including CA angioplasty/stent (n=3), heart transplantation (n=2) and redo-PCABG (n=1).
Conclusions: PCABG and CA procedures are suitable surgical options in a pediatic patients with impaired myocardial perfusion, following iatrogenic and/or congenital CA stenosis, which increases operative and mid-term survival
- © 2012 by American Heart Association, Inc.