Abstract 20624: Coronary Revascularization Procedures in Children: A Review of the Pediatric Cardiac Care Consortium
Introduction: Coronary revascularization via coronary arterial bypass grafting (CABG) or percutaneous coronary intervention/stents (PCI) is rarely required in children. We report frequency, indications, in-hospital mortality and follow-up of coronary revascularization procedures from a registry of pediatric cardiac centers.
Methods: Retrospective cohort study (1982-2007) from the Pediatric Cardiac Care Consortium for CABG or PCI in children (<18 years). We collected age at procedure, primary diagnosis, indication, timing relative to other procedures, in-hospital mortality, and long term follow up data.
Results: We identified 109 patients with coronary revascularization procedures (males 64, females 45). Of them, 92 were primary CABG (median age 8.4 years, range 3 days - 17.4 years) and 17 primary PCI (median age 10.2 years, range 77 days-17.0 years). In total, 79 were performed for surgical heart diseases and 30 for various medical conditions (e.g. Kawasaki disease, heart transplantation). The most common indications were congenital coronary artery abnormalities (CCAA) (n=24), stenosis as part of supra-aortic stenosis (n=8), and sequelae from arterial switch operation (ASO) (n=22) or other operations involving risk for coronary artery injury (n=19). Late coronary artery compromise was related to prior reimplantation as part of ASO (n=14), procedure for anomalous coronary artery origin (n=9) or after aortic root surgery (n=7). There were 13 deaths, with 12 of them related to rescue revascularization during or shortly after another cardiac procedure. Follow up data existed for 44 of the 97 surviving patients (median time of f/u 24 months, range 1 - 117 months) with documented patency in 22 of them; the remaining patients had partial or total occlusion of the graft or stent with 4 of them needing additional revascularization procedure, 5 receiving heart transplantation, 3 dying at a later time, and 1 needing automatic implantable defibrillator (AICD).
Conclusions: Coronary revascularization procedures can be performed successfully in children after a variety of surgical procedures, CCAA, and medical conditions affecting the coronary arteries. Outcomes are dependent on indication, with the highest mortality in rescue procedures.
Author Disclosures: K. Thammineni: None. J. Vinocur: None. B. Harvey: Research Grant; Significant; NIH/NHLBI. J. St Louis: Research Grant; Significant; NIH/NHLBI. L. Kochilas: Research Grant; Significant; NIH/NHLBI.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.