State-of-the-Art Pediatric Coronary Artery Bypass Surgery: a Literature Review

Abstract Objective: To examine the results of various myocardial revascularization techniques in pediatric patients to better understand the strategies for surgical treatment of coronary artery pathologies. Methods: We analyzed 61 publications dedicated to the indications, methods, and results of coronary bypass surgery in children. Due to the small size of this cohort, case reports are also included in our review. Results: The main indications for coronary bypass grafting in children are Kawasaki disease, myocardial revascularization as a necessary procedure during the congenital cardiac surgery, to manage intraoperative iatrogenic damage to coronary arteries, and homozygous familial hypercholesterolemia. The use of internal thoracic arteries as conduits for coronary bypass grafting in children with Kawasaki disease showed significantly better results in long-term functionality compared to autovenous conduits (87% and 44%, respectively, P<0.001). Acute and late coronary events after arterial switch operation for the transposition of the great arteries, anomalous origin of the left coronary artery from the pulmonary artery, and left main coronary artery atresia are the main congenital heart diseases where surgical correction involves interventions on the coronary arteries. Conclusion: The internal thoracic artery is a reliable and durable conduit that demonstrates proven growth potential in children.

【摘要】
研究目的：旨在评估各类心肌血运重建技术在儿科患者中的应用结局，以进一步明晰冠状动脉病变的外科治疗策略。
研究方法：本研究纳入分析了61篇聚焦儿童冠状动脉旁路移植术的适应证、手术方式及临床结局的文献。鉴于该类研究的病例队列规模有限，本次综述同时纳入了病例报告类文献。
研究结果：儿童冠状动脉旁路移植术的主要适应证包括川崎病（Kawasaki disease）、先天性心脏手术中必需的心肌血运重建操作、术中医源性冠状动脉损伤处理，以及纯合子家族性高胆固醇血症（homozygous familial hypercholesterolemia）。针对川崎病患儿采用胸廓内动脉（internal thoracic arteries）作为冠状动脉旁路移植桥血管的远期通畅率显著优于自体静脉桥血管（autovenous conduits），二者分别为87%与44%（P<0.001）。大动脉转位（transposition of the great arteries）、左冠状动脉异常起源于肺动脉（anomalous origin of the left coronary artery from the pulmonary artery）以及左主干冠状动脉闭锁（left main coronary artery atresia）是三类主要的先天性心脏病，对这类患者实施动脉调转术（arterial switch operation）时需进行冠状动脉相关干预，术后可出现急性及远期冠状动脉事件。
研究结论：胸廓内动脉是一种可靠且耐用的桥血管，在儿科患者中已被证实具备良好的生长潜能。