Eric Bergoënd, Olivier Raisky, Alexandra Degandt, Daniel Tamisier, Daniel Sidi, Pascal Vouhé; Hôpital Necker - Enfants Malades, Paris, France
Objective: To report our continued experience with both coronary artery proximal patch arterioplasty (CAPPA) and coronary artery bypass (CAB) in infants and children, to document the mid-term patency rate and evaluate functional results.Methods: Data concerning all consecutive patients operated on for proximal coronary artery critical stenosis or occlusion, in our institution, between 1992 and 2004 were retrospectively analysed.
Results: Twenty five patients underwent a CAPPA (22 of the left main trunk). Indication was postoperative coronary obstruction in 22 patients (after arterial switch for transposition of the great arteries in 19 patients and after anomalous origin of coronary artery repair in 3 patients) and congenital stenosis in 3 patients (Williams syndrome). Eight patients had a CAB including 6 left internal thoracic artery to left anterior descending (LITA-LAD) bypass. Indication was postoperative coronary obstruction in all patients (after arterial switch in 2 patients). Mean age at surgery was 5.3 ± 4.4 years (range 1 month - 15.9 years) for CAPPA and 8.0 ± 4.1 years (2.6 - 13.0 years) for CAB. One CAPPA patient died during the perioperative period owing to a cardiogenic shock. One CAB patient died suddenly 3.5 months after surgery of unknown cause. All other patients were alive after a mean follow-up of 3.4 ± 3.1 years (range 2.4 months - 11.2 years) for CAPPA and 4.4 ± 2.8 years (range 11.2 months - 8.7 years) for CAB. Two patients had a CAB 2.6 and 5.7 years after CAPPA due to critical proximal restenosis on control angiography. Survival free of ischemic events was 87.5 % at 5 years for both CAPPA and CAB. In a subset of 18 CAPPA patients who underwent a coronary angiography, 16 (64%) showed a satisfactory result. Amongst the 5 alive patients who didn't have a control angiography, 4 remained symptom free. Over the 6 CAB patients who underwent a coronary angiography, 3 (38%) presented a satisfactory result ; in one patient the graft was occluded ; one patient showed a complete string sign of the mammary artery (LITA-LAD bypass) and one patient presented a severe distal anastomosis stenosis. Overall, 18 CAPPA patients (72%) and 5 CAB patients (63%) remained symptom free.
Conclusion: CAPPA is a reliable procedure in children, with good mid-term patency rate and clinical functional status. When a myocardial revascularization is required in children it is probably better, if possible, to realize a CAPPA rather than a CAB.
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