Key result
ITA grafts achieve ~87% long-term patency in Kawasaki disease CABG, outperforming saphenous vein grafts.
Why the study?
Despite improvements in acute Kawasaki disease treatment, a subset of patients develops coronary sequelae requiring coronary revascularization.
What are the optimal revascularization strategies and their long-term outcomes for patients with Kawasaki disease-related coronary sequelae?
What are the optimal revascularization strategies and their long-term outcomes for patients with Kawasaki disease-related coronary sequelae?
CABG using arterial conduits, particularly internal thoracic artery grafts, represents the gold standard for revascularization in Kawasaki disease-related coronary sequelae, offering excellent long-term survival.
Supports ITA-CABG for long-term survival in pediatric Kawasaki coronary disease; leaves open optimal selection and surveillance protocols.
Kawasaki disease (KD) is the leading cause of acquired coronary artery disease in children worldwide. Despite improvements in acute treatment, a subset of patients develops persistent aneurysms, progressive stenosis, thrombosis, and ischemic heart disease requiring coronary revascularization. This review summarizes long-term clinical and surgical outcomes of revascularization strategies for KD-related coronary sequelae, focusing on graft selection, growth potential, patency, survival, and current surgical strategies. Coronary artery bypass grafting (CABG), particularly using internal thoracic artery (ITA) grafts, has demonstrated excellent long-term survival (> 90% at 20–30 years) and superior graft patency compared with saphenous vein grafts. Event-free survival declines over time, emphasizing the need for lifelong surveillance. Preoperative left ventricular function is the strongest predictor of long-term outcome. Percutaneous coronary intervention plays a limited role in growing and small pediatric patients due to severe calcification and complex aneurysmal anatomy, but may be considered selectively in older patients. CABG using arterial conduits, particularly ITA grafts, represents the gold standard for revascularization in KD-related coronary sequelae. Long-term outcomes are excellent, but lifelong surveillance remains essential.
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Kim et al. (2026) conducted a review in Kawasaki disease-related coronary sequelae (n=3). Coronary artery bypass grafting (CABG) with internal thoracic artery (ITA) grafts vs. Saphenous vein grafts (SVG) was evaluated. Coronary artery bypass grafting using internal thoracic artery grafts provides excellent long-term outcomes for Kawasaki disease-related coronary sequelae, with 20-year patency rates of approximately 87% compared to 44% for saphenous vein grafts.
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