Faculty Collaboration Database

Pediatric coronary artery revascularization: a European multicenter study. Ann Thorac Surg 2013 Sep;96(3):898-903

Date

07/31/2013

Pubmed ID

23891408

DOI

10.1016/j.athoracsur.2013.05.006

Scopus ID

2-s2.0-84883251682 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

BACKGROUND: We sought to evaluate the hospital and midterm results of different surgical revascularization techniques in pediatric patients within the European Congenital Heart Surgeons Association.

METHODS: From 1973 to 2011, 80 patients from 13 European Congenital Heart Surgeons Association centers underwent 65 pediatric coronary artery bypass grafting (PCABG) and 27 other coronary artery procedures (OCAP; 12 patients had combined PCABG and other coronary artery procedures). Excluded were patients with Kawasaki disease. Median age at the time of coronary procedure was 2.3 years (range, 2 days to 16.9 years); 33 patients (41.2%) were younger then 12 months. An emergency procedure was necessary in 34 patients (42.5%).

RESULTS: Twelve patients (15%) died in the hospital; age at surgery (p=0.02) and the need for an emergent procedure (p=0.0004) were related to hospital mortality. Median follow-up time was 7.6 years (range, 0.9 to 23 years). There were 3 late cardiac deaths, all after a median time of 4 years (range, 9 months to 8.8 years) after PCABG. Fourteen patients (20.5%) presented with symptoms, including congestive heart failure (n=10) and angina (n=4), that were significantly associated with a low ejection fraction (p<0.001) and the presence of moderate or severe mitral valve regurgitation (p=0.0003). Six patients underwent a reintervention for impaired myocardial perfusion; all of them had a stenotic or atretic PCABG (p=0.001), and the majority were symptomatic (5 of 6 patients; 83.3%; p=0.001).

CONCLUSIONS: Both PCABG and other coronary artery procedures are suitable surgical options in pediatric patients with impaired myocardial perfusion, which increases operative and midterm survival. Such population of patients needs to be followed for life to prevent and treat any possible cause of further myocardial ischemia.

Author List

Vida VL, Torregrossa G, De Franceschi M, Padalino MA, Belli E, Berggren H, Çiçek S, Ebels T, Fragata J, Hoel TN, Horer J, Hraska V, Kostolny M, Lindberg H, Mueller C, Pretre R, Rosser B, Rubay J, Schreiber C, Speggiorin S, Tlaskal T, Stellin G, European Congenital Heart Surgeons Association (ECHSA)

Author

Viktor Hraska MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child, Preschool
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease
Databases, Factual
Europe
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Heart Defects, Congenital
Hospital Mortality
Humans
Infant
Infant, Newborn
Internal Mammary-Coronary Artery Anastomosis
Male
Retrospective Studies
Risk Assessment
Severity of Illness Index
Societies, Medical
Survival Rate
Treatment Outcome