Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease Soichiro Kitamura, MDa (by invitation), Yoichi Kameda,

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Presentation transcript:

Long-term outcome of myocardial revascularization in patients with Kawasaki coronary artery disease Soichiro Kitamura, MDa (by invitation), Yoichi Kameda, MDa (by invitation), Toshio Seki, MDa (by invitation), Kanji Kawachi, MDa (by invitation), Masahiro Endo, MDb (by invitation), Yasuo Takeuchi, MDc (by invitation), Tomisaku Kawasaki, MDd (by invitation), Yasunaru Kawashima, MDe The Journal of Thoracic and Cardiovascular Surgery Volume 107, Issue 3, Pages 663-674 (March 1994) DOI: 10.5555/uri:pii:S0022522394703213 Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 1 Age distribution of the 170 male and female patients at the time of operation. The mean age was 10.6 ± 8.1 years, ranging from 1 to 44 years with a peak at 5 to 7 years. About one quarter of the patients were female. Sixteen adults (9.4%) over 20 years of age were also enrolled in this multicenter study because of their characteristic angiographic findings and the complete lack of risk factors for atherosclerotic heart disease. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 2 Coronary artery obstruction caused by Kawasaki disease in surgical patients. Obstructive disease developed at the inflow or outflow sites of the coronary aneurysms, which were generally located in the proximal part of the coronary artery tree. The left anterior descending artery (LAD) was most commonly involved, followed by the right coronary artery (RCA), left circumflex artery (LCX),and the left main trunk (LMT) in that order. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 3 Actuarial survival of patients with at least one ITA to the LAD coronary artery (ITA group) and patients with only SVGs (SVG group). There was a significant difference in survival at 90 months after the operation (p < 0.05). The use of an ITA graft was a strong (p < 0.003) predictor of better late postoperative survival. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 4 Comparison of actuarial graft patency rates between arterial grafts(A) (n = 151) and venous grafts(B) (n = 126). Arterial grafts showed a significantly higher angiographic patency than venous grafts.Occlusion of venous grafts was common during the first few years after operation. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 5 Comparison of actuarial graft patency rates between arterial grafts(A) (n = 39) and venous grafts(B) (n = 81) for the right and circumflex arteries. Arterial grafts also showed a significantly higher patency than venous grafts. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 6 Comparison of SVG and arterial graft patency in patients under 7 years of age at operation. SVG patency was only 27.7% ± 8.1% and arterial graft patency was70.3% ± 10.0% at 84 months after the operation (p < 0.005). The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 7 Comparison of SVG and arterial graft patency in patients over 8 years of age. SVG patency was 65.4% ± 7.9% and arterial graft patency was 83.5% ± 7.1% at 90 months after the operation (p = not significant). The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 8 Postoperative cardiac events. Approximately 70% of the patients had no cardiac events after the operation. There was a relatively high overall postoperative event rate of 24.4%, but there were no differences in the prevalence of nonfatal cardiac events between the patients with ITA grafts (24.6%) and those with only SVGs (24.1%). MI, Myocardial infarction. The Journal of Thoracic and Cardiovascular Surgery 1994 107, 663-674DOI: (10.5555/uri:pii:S0022522394703213) Copyright © 1994 Mosby, Inc. Terms and Conditions