National survey of coronary artery bypass grafting in patients with coronary artery lesions caused by Kawasaki disease in Japan from 2008 to 2019

Abstract

Objective

The study objective was to know how the results of patients who underwent coronary artery bypass grafting for coronary arterial lesions caused by Kawasaki disease have changed in the past half-century after the first report of Kawasaki disease.

Methods

We investigated the national results of coronary artery bypass grafting in patients with Kawasaki disease who underwent the procedures between 2008 and 2019 from the Japan Cardiovascular Surgery Database Organization. The prevalence and outcome of patients with coronary artery bypass grafting were clarified. The factors that affected the condition upon discharge were analyzed. Furthermore, the outcomes of the patients in the late period after discharge were surveyed by questionnaires in 2021.

Results

A total of 343 patients were identified. Coronary artery bypass grafting after Kawasaki disease has been performed in approximately 40 patients per year recently. There were 264 male patients (77.0%) and 79 female patients (23.0%). The median age at the time of the operation was 39 years (5th-95th percentile, 13-72). The 30-day-operative mortality was 0.9%. Of the 183 patients (53.8%) with the quwtionaires after discharge, 176 survived (96.2%), and 7 died (3.8%). The 10-year survival rate was 94% (95% CI, 87-97%) (n = 183). The 5-year survivals depended on the preoperative left ventricular ejection fraction, which was 72% (95% CI, 13-96) (n = 9) for the poor group (left ventricular ejection fraction <30%), 98% (95% CI, 87-100) (n = 104) for the preserved group (≥60%), and 94% (95% CI, 81-98) (n = 70) for the intermediate group (≥30% but <60%) (P < .05).

Conclusions

A half-century after the first report of Kawasaki disease, the ages of the patients who undergo coronary artery bypass grafting in this population have changed from children to young adults. Although the preoperative left ventricular function affected the long-term outcome, the operative results were good.