Abstract
ObjectiveTo examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies.MethodsWe analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review.ResultsThe main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P<0.001). Acute and late coronary events after arterial switch operation for the transposition of the great arteries, anomalous origin of the left coronary artery from the pulmonary artery, and left main coronary artery atresia are the main congenital heart diseases where surgical correction involves interventions on the coronary arteries.ConclusionThe internal thoracic artery is a reliable and durable conduit that demonstrates proven growth potential in children.
Highlights
Over the past few decades, there has been almost no controversy with respect to different approaches in myocardial revascularization in adult patients with coronary artery disease (CAD)
Clear criteria have been developed for choosing a particular technique of myocardial revascularization — in particular, percutaneous interventions, coronary artery bypass grafting (CABG), or hybrid techniques, depending on the severity of myocardial ischemia, the degree and morphology of coronary artery lesions, and the presence of CAD complications and comorbid pathology[1]
It should be noted that autovenous conduits were used exclusively in the early stages of the development of pediatric CABG in the treatment of Kawasaki disease (KD); because of unsatisfactory long-term patency, it was decided to abandon the routine use of this graft, especially in children under four years of age[37]
Summary
The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P
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