Pediatric coronary artery bypass for Kawasaki, congenital, post arterial switch, and iatrogenic lesions

Background. Pediatric coronary artery bypass (PCAB) has been recently emplo yed for expanding indications to treat acquired, congenital, post arterial switch, and other iatrogenic pediatric coronary artery problems. Methods. Between 1987 and 1998, 3 infants and 13 children (n = 16, mean age 6.1 years, range 2 months-18 years) underwent one or more internal thoraci c artery (ITA) to coronary artery (CA) bypass grafts for Kawasaki disease ( n = 4), congenital lesions (n = 3), post arterial switch (n = 4), and other iatrogenic obstructions (n = 5). Proximal left main CA arterioplasty was p erformed concurrently with ITA-CA bypass in 4 patients. Results. Survival is 93.8%. All bypass grafts in surviving patients are pat ent 2 months-ii years postoperation. The II elective patients are well (NYH A I-II). The 5 emergent operations were performed in 2 infants and 3 adoles cents who had poor ventricular function prior to ITA-CA bypass due to iatro genic injuries in 3, congenital critical left main stenosis in 1, and intra operative iatrogenic coronary injury in 1. The 3 adolescents fared worse, r esulting in death in the first, cardiac transplantation in the second, and full recovery in the third. The 2 infants have steadily improving ventricul ar function. Conclusions. ITA-CA bypass can be successfully performed in infants and chi ldren for expanding elective and life-saving indications with excellent res ults. Poor preoperative ventricular function often persists, especially in those older children with iatrogenic injuries, and may result in death or c ardiac transplantation. (C) 1999 by The Society of Thoracic Surgeons.