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J Thorac Cardiovasc Surg 2010;139:349-353
© 2010 The American Association for Thoracic Surgery

Congenital Heart Disease

Outcome of coronary artery bypass grafting performed in young children

^a Pediatric Cardiology Unit, Hopital Clocheville, CHRU et Université François Rabelais de Tours, Tours, France
^b Pediatric Cardiology and Cardiac Surgery Department, Marie-Lannelongue Hospital, Le-Plessis-Robinson, France
^c Cardiac Surgery Department, hôpital Necker-Enfants Malades, and Université Paris-Descartes, Paris, France
^d Cardiac Surgery Department Hôpital, Hôpital Clocheville, CHRU et Université François Rabelais de Tours, Tours, France
^e Cardiologie pédiatrique, Hôpital d'Enfants, CHU Toulouse, France
^f Clinique de La Louvière, Lille, France
^g Pediatric Cardiology Department, and hôpital Necker-Enfants Malades, Université Paris-Descartes, Paris, France

Received for publication February 10, 2009; revisions received June 2, 2009; accepted for publication July 23, 2009.

^_* Address for reprints: Antoine Legendre, MD, Cardiologie pédiatrique, CHU Necker, 149 rue de Sèvres, 75743 Paris cedex 15, France. (Email: antoine.legendre{at}nck.aphp.fr).

Objectives: The long-term patency rate of coronary artery bypass grafting for which arterial grafts are used is known to be high in the pediatric population. However, this issue remains uncertain in children under 3 years of age. Here, we report the outcome in this specific population.

Methods: From July 1988 to July 2007, 18 children less than 3 years of age (age at operation, 0.1–35 months; median, 4 months) underwent 20 coronary artery bypass graft operations using an arterial graft. Indications for bypass grafting were coronary artery complications related to the arterial switch operation for transposition of the great arteries in 12 patients (coronary obstruction in 8 patients, peroperative coronary anomalies precluding coronary transfer in 4 patients), congenital anomalies of the coronary arteries in 4 patients, and Kawasaki disease in 2 patients.

Results: After a mean follow-up of 55 months (range, 1–176 months; median, 41 months), patency of 19 bypass grafts was assessed. One was occluded and 2 have necessitated a percutaneous procedure. Two patients died suddenly (1 with an occluded graft and 1 with a patent graft and hypertrophic myocardiopathy) 3.5 and 4.6 months, respectively, after bypass grafting.

Conclusions: Coronary artery bypass grafting should be considered as a possible alternative for coronary revascularization in young children. Although our series shows quite a good patency rate, this procedure remains a technical challenge and requires careful follow-up.

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