Journal of Nippon Medical School: Vol.71 No.4 page.279

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ArticleTitle Optimal Time of Surgical Treatment for Kawasaki Coronary Artery Disease

AuthorList Hitoshi Yamauchi¹, Masami Ochi¹, Masahiro Fujii¹, Kazuhiro Hinokiyama¹, Hiroya Ohmori¹, Takashi Sasaki¹, Ei Ikegami¹, Yoko Uchikoba², Shunichi Ogawa² and Kazuo Shimizu¹

Affiliation ¹Division of Cardiovascular Surgery Department of Surgery, Nippon Medical School
²Department of Pediatrics, Nippon Medical School

Language EN

Volume 71

Issue 4

Year 2004

Page 279-286

Received February 24, 2004

Accepted April 12, 2004

Keywords coronary artery bypass grafting, coronary artery aneurysm, Kawasaki disease

Abstract
Background: The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm, while the indications for surgical therapy remain controversial. We have adopted coronary artery bypass grafting (CABG) even in young children for giant coronary aneurysms (more than 8 mm diameter) with or without a stenotic region when myocardial ischemia is detected. We hypothesized that a shorter time-period from diagnosis of acute Kawasaki disease (KD) to CABG would lead to better postoperative results. To elucidate the validity of our strategy, we evaluated preoperative patient characteristics and long-term outcome.

Methods: Twenty-one patients (mean age: 12.0 years old) with Kawasaki coronary disease had undergone CABG during the last 12 years. The mean age at the time of acute KD was 2.7 years and the mean time range from diagnosis of acute KD to CABG was 8.1 years. The incidence of preoperative reduced ventricular function was 10 per 21 patients (47.6%). A multivariate logistic regression analysis using patient characteristics showed that the time range from acute KD to CABG was the only predictor for ventricular functional deterioration (p=0.03, odds ratio 1.55. 95%CI: 1.033∼2.325). Based on these results, we divided the patients into two groups of short time range (mean: 3.7 years; group S) and long time range (mean: 13.9 years; group L).

Results: Preoperative left ventricular functional deterioration was recognized more frequently in group L (9/9, 100%) than in group S (1/12, 8.3%)(p<0.01). Myocardial infarction was documented significantly higher in the group L (6/9, 66.7%) than group S (1/12, 8.3%)(p=0.04). There was no surgical mortality in either group. The arterial grafts demonstrated good potential for growth and graft patency was 96.9%. Moreover, seven of the giant aneurysms proximal to the graft anastomosis showed complete thrombotic occlusion after CABG without development of myocardial infarction. The cardiac events free rate of group L and group S was 66.7% and 100%, respectively, during the postoperative follow up periods of 5.5±1.1 years (group L) and 4.7±1.1 years (group S).

Conclusions: We successfully applied CABG for Kawasaki coronary disease. Based on our experience, a short interval after acute KD appears to be ideal for surgical treatment of Kawasaki coronary disease.

Correspondence to Hitoshi Yamauchi, MD, Division of Cardiovascular Surgery Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
hito-y@nms.ac.jp

ArticleTitle	Optimal Time of Surgical Treatment for Kawasaki Coronary Artery Disease
AuthorList	Hitoshi Yamauchi¹, Masami Ochi¹, Masahiro Fujii¹, Kazuhiro Hinokiyama¹, Hiroya Ohmori¹, Takashi Sasaki¹, Ei Ikegami¹, Yoko Uchikoba², Shunichi Ogawa² and Kazuo Shimizu¹
Affiliation	¹Division of Cardiovascular Surgery Department of Surgery, Nippon Medical School ²Department of Pediatrics, Nippon Medical School
Language	EN
Volume	71
Issue	4
Year	2004
Page	279-286
Received	February 24, 2004
Accepted	April 12, 2004
Keywords	coronary artery bypass grafting, coronary artery aneurysm, Kawasaki disease
Abstract	Background: The major complication of Kawasaki coronary disease is myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm, while the indications for surgical therapy remain controversial. We have adopted coronary artery bypass grafting (CABG) even in young children for giant coronary aneurysms (more than 8 mm diameter) with or without a stenotic region when myocardial ischemia is detected. We hypothesized that a shorter time-period from diagnosis of acute Kawasaki disease (KD) to CABG would lead to better postoperative results. To elucidate the validity of our strategy, we evaluated preoperative patient characteristics and long-term outcome. Methods: Twenty-one patients (mean age: 12.0 years old) with Kawasaki coronary disease had undergone CABG during the last 12 years. The mean age at the time of acute KD was 2.7 years and the mean time range from diagnosis of acute KD to CABG was 8.1 years. The incidence of preoperative reduced ventricular function was 10 per 21 patients (47.6%). A multivariate logistic regression analysis using patient characteristics showed that the time range from acute KD to CABG was the only predictor for ventricular functional deterioration (p=0.03, odds ratio 1.55. 95%CI: 1.033∼2.325). Based on these results, we divided the patients into two groups of short time range (mean: 3.7 years; group S) and long time range (mean: 13.9 years; group L). Results: Preoperative left ventricular functional deterioration was recognized more frequently in group L (9/9, 100%) than in group S (1/12, 8.3%)(p<0.01). Myocardial infarction was documented significantly higher in the group L (6/9, 66.7%) than group S (1/12, 8.3%)(p=0.04). There was no surgical mortality in either group. The arterial grafts demonstrated good potential for growth and graft patency was 96.9%. Moreover, seven of the giant aneurysms proximal to the graft anastomosis showed complete thrombotic occlusion after CABG without development of myocardial infarction. The cardiac events free rate of group L and group S was 66.7% and 100%, respectively, during the postoperative follow up periods of 5.5±1.1 years (group L) and 4.7±1.1 years (group S). Conclusions: We successfully applied CABG for Kawasaki coronary disease. Based on our experience, a short interval after acute KD appears to be ideal for surgical treatment of Kawasaki coronary disease.
Correspondence to	Hitoshi Yamauchi, MD, Division of Cardiovascular Surgery Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan hito-y@nms.ac.jp