Twenty-Five-Year Outcome of Pediatric Coronary
Artery Bypass Surgery for Kawasaki Disease
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.
2009年11月6日金曜日
2009年11月3日火曜日
人工弁を埋め込んだ患者の予後に、６分間歩行が有効と発表
ritish Cardiovascular Society
Original articles
Preoperative 6 Minute Walk Test Adds Prognostic Information to Euroscore in Patients Undergoing Aortic Valve Replacement
Diego Perez de Arenaza 1, John Pepper 2, Belinda Lees 2, Fernando Rubinstein 1, Fiona Nugara 2, Michael Roughton 2, Marek Jasinski 3, Oscar Bazzino 1 and Marcus Flather 2*
1 Hospital Italiano of Buenos Aires, Argentina
2 Royal Brompton Hospital, United Kingdom
3 Department Of Cardiac Surgery, Medical University Of Silesia, Poland
Accepted 5 May 2009
Abstract
Aims: We investigated the additive prognostic value of the 6MWT to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR).
Methods and results: 208 patients with severe AS underwent six minute walk test (6MWT) prior to aortic valve replacement (AVR), as part of a randomized trial (ASSERT) comparing stented and stentless aortic valves.
Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n=14) in patients walking <300 m compared to 4% (n=4) in those who walked 300 m (p= 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6 minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09-0.85, p=0.025).
Conclusions: The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis prior to AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score
Original articles
Preoperative 6 Minute Walk Test Adds Prognostic Information to Euroscore in Patients Undergoing Aortic Valve Replacement
Diego Perez de Arenaza 1, John Pepper 2, Belinda Lees 2, Fernando Rubinstein 1, Fiona Nugara 2, Michael Roughton 2, Marek Jasinski 3, Oscar Bazzino 1 and Marcus Flather 2*
1 Hospital Italiano of Buenos Aires, Argentina
2 Royal Brompton Hospital, United Kingdom
3 Department Of Cardiac Surgery, Medical University Of Silesia, Poland
Accepted 5 May 2009
Abstract
Aims: We investigated the additive prognostic value of the 6MWT to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR).
Methods and results: 208 patients with severe AS underwent six minute walk test (6MWT) prior to aortic valve replacement (AVR), as part of a randomized trial (ASSERT) comparing stented and stentless aortic valves.
Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n=14) in patients walking <300 m compared to 4% (n=4) in those who walked 300 m (p= 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6 minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09-0.85, p=0.025).
Conclusions: The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis prior to AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score
2009年11月1日日曜日
2009年10月30日金曜日
2009年10月29日木曜日
2009年10月27日火曜日
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