Key result
Internal thoracic artery grafts demonstrated the best long-term patency rates compared to other conduits in patients undergoing CABG for Kawasaki disease (HR 0.33; 95% CI 0.17-0.66).
Why the study?
It was unclear which CABG strategy provides better graft patency and long-term outcomes in patients with Kawasaki disease.
Does the use of arterial conduits improve graft patency and reduce long-term mortality compared to venous conduits in patients undergoing CABG for Kawasaki disease?
Meta-Analysis (n=1,191)
Does the use of arterial conduits improve graft patency and reduce long-term mortality compared to venous conduits in patients undergoing CABG for Kawasaki disease?
Hazard Ratio: 0.33 (95% CI 0.17–0.66)
In patients with Kawasaki disease undergoing CABG, the use of arterial conduits, particularly internal thoracic arteries, is associated with superior long-term graft patency and reduced mortality compared to venous grafts.
Background:Kawasaki disease (KD) is a systemic inflammatory condition occurring predominantly in children. Coronary artery bypass grafting (CABG) is performed in the presence of inflammation and aneurysms of the coronary arteries. The objectives of our study were to assess which CABG strategy provides better graft patency and long-term outcomes. Methods:A systematic review using Medline, Cochrane and Scopus databases was performed by February 2020, incorporating a network meta-analysis, performed by random-effect model within a Bayesian framework, and pooled prevalence of adverse outcomes. Hazard ratios (HR) and corresponding 95% credible intervals (CI) were calculated by Markov chain-Monte Carlo methods. Results:Among 581 published reports, 32 studies were enrolled, including 1191 patients undergoing CABG for KD. Graft patency of internal thoracic arteries (ITA), saphenous veins (SV) and other arteries (gastroepiploic artery and radial artery) were compared. ITAs demonstrated the best patency rates at long-term follow-up (HR 0.33, 95% CI:0.17-0.66). Pooled prevalence of early mortality after CABG was 0.28% (95% CI:0.00-0.73%,I²=0%,tau²=0), with 63/1108 and 56/1108 patients, respectively, undergoing interventional procedures and surgical re-interventions during follow-up. Pooled prevalence was 3.97% (95% CI:1.91-6.02%,I²=60%,tau²=0.0008) for interventional procedures and 3.47% (95% CI:2.26-4.68%,I²=5%,tau²<0.0001) for surgical re-interventions. Patients treated with arterial, venous and mixed (arterial plus second venous graft) CABG were compared to assess long-term mortality. Mixed CABG (HR 0.03,95% CI: 0.00-0.30) and arterial CABG (HR 0.13, 95% CI: 0.00-1.78) showed reduced long-term mortality compared with venous CABG. Conclusions:CABG in KD is a safe and effective procedure. Use of arterial conduits provides better patency rates and lower mortality at long-term follow-up.
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Salsano et al. (2020) conducted a meta-analysis in Kawasaki disease (n=1,191). Internal thoracic artery grafts vs. Saphenous vein grafts was evaluated on Graft patency at long-term follow-up (HR 0.33, 95% CI 0.17-0.66). Internal thoracic artery grafts demonstrated the best long-term patency rates compared to other conduits in patients undergoing CABG for Kawasaki disease (HR 0.33; 95% CI 0.17-0.66).
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