Surgical Myocardial Revascularization Outcomes in Kawasaki Disease: Systematic Review and Meta-analysis

Overview

Journal Open Med (Wars)

Specialty General Medicine

Date 2021 Mar 22

PMID 33748422

Citations 1

Authors

Antonio Salsano

Jingda Liao

Ambra Miette

Massimo Capoccia

Giovanni Mariscalco

Francesco Santini

Antonio F Corno

Affiliations

Soon will be listed here.

Abstract

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 early and long-term outcomes.

Methods: A systematic review using Medline, Cochrane, and Scopus databases was performed in 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 selected, including 1,191 patients undergoing CABG for KD. Graft patency of internal thoracic arteries (ITAs), saphenous veins (SV), and other arteries (gastroepiploic artery and radial artery) was 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%, = 0%, tau = 0), with 63/1,108 and 56/1,108 patients, undergoing interventional procedures and surgical re-interventions during follow-up, respectively. Pooled prevalence was 3.97% (95% CI: 1.91-6.02%, = 60%, tau = 0.0008) for interventional procedures and 3.47% (95% CI: 2.26-4.68%, = 5%, tau <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 procedure. The use of arterial conduits provides better patency rates and lower mortality at long-term follow-up.

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