川崎病 日本医師のすばらしい文献

Twenty-Five-Year Outcome of Pediatric Coronary Artery Bypass Surgery for Kawasaki Disease
7/12/2009
Journal: Circulation
Citation: 2009;120:60-68
Authors: Soichiro Kitamura, Etsuko Tsuda, Junjiro Kobayashi, Hiroyuki Nakajima, Yoshiro Yoshikawa, Toshikatsu Yagihara, Akiko Kada
Background The long-term outcome of pediatric coronary artery bypass for patients with severe inflammatory coronary sequelae secondary to Kawasaki disease is unknown.
Methods and Results One hundred fourteen children and adolescents ranging in age from 1 to 19 (median, 10) years at operation were followed up for as long as 25 years with a median of 19 years. The number of distal anastomoses was
ｱ 0.8 per patient, and the internal thoracic artery was used in all but 3, most frequently for left anterior descending artery lesions. Saphenous vein grafts were used in 24 patients, mostly for non-left anterior descending artery lesions. Patients underwent multiple angiograms to evaluate their coronary and graft status There was no operative or hospital mortality. Both 20- and 25-year survival rates were 95% (95% confidenc interval [CI], 88 to 98). Five deaths occurred, all cardiac in origin. Cardiac event-free rates at 20 and 25 yea were 67% and 60% (95% CI, 46 to 72), respectively. Percutaneous coronary intervention and reoperation w the most common events. Overall, the 20-year graft patency rate was 87% (95% CI, 78 to 93) for internal thoracic artery grafts (n=154) and 44% (95% CI, 26 to 61) for saphenous vein grafts (n=30) (P<0.001), and the rate for non-left anterior descending artery lesions was also significantly better for arterial grafts (87% [95% CI, 73 to 94]; n=59) than for saphenous vein grafts (42% [95% CI, 23 to 60]; n=27) (P=0.002). Eighty eight patients (77%) remain on medications, but all 109 survivors are presently symptom free in their daily activities.
Conclusions Although the 25-year survival was excellent after pediatric coronary bypass for Kawasaki disease, the event free rate declined progressively. This reality mandated continued follow-up. Reinterventions successfully managed most cardiac events. An internal thoracic artery graft was the most favorable for children.