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J Thorac Cardiovasc Surg 2008;136:305-306
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Carl L. Backer (Chicago, Ill). Dr Bergoënd, I congratulate you on a very nice presentation. You and your colleagues have presented what I believe is the largest series reported to date of CAPPA. You have also shared with us a smaller experience with coronary bypass grafting in children. You have presented a total of 33 children undergoing myocardial revascularization, 25 with a proximal coronary artery patch, and the most common indication was postarterial switch in 21 patients. Given your overall arterial switch experience of nearly 500 patients, this looks like an incidence of about 4%. You concluded that the results with the patch are quite good, but you were disappointed with the results of CABG, with only 38% of the patients having a good postoperative angiogram.

Our series at Children's Memorial Hospital is essentially, and interestingly, the mirror image of your series, probably reflecting a different patient population and pathology at presentation. In the past 20 years, Gus Mavroudis and I have done 27 CABGs and only 5 proximal coronary artery patches. In our series the most common indications were Kawasaki disease, which was present in 9 patients; postarterial switch or the Ross procedure, which was present in 7 patients; and congenital coronary anomalies, which were present in 6 patients. We had 3 deaths, very similar to your series, but the patency rate of coronary bypass grafting in our long%2011term evaluation was 88%. I guess I would agree with you that in your series the disappointing results with coronary bypass grafting is probably due to the small number of patients and the varying indications. However, I believe it remains a very important strategy for some patients in whom a patch is not an option.

I have 4 questions . . . [Full Text of this Article]