Midterm outcomes of coronary artery bypass grafting for Kawasaki disease in children: A multicenter retrospective study in China

To the Editor: Kawasaki disease (KD) is the most common systemic vasculitis in childhood. Coronary artery complications of KD have become a significant cause of acquired heart disease in children.[1,2] Despite the reduction in the overall occurrence rate of coronary artery aneurysms (CAA) due to the administration of intravenous immunoglobulin, the development of giant coronary artery aneurysms (GCAA) is still one of the most severe long-term sequelae of KD, profoundly increasing the risk of myocardial ischemia, myocardial infarction, and sudden death.[3] Current management strategies for coronary lesions in KD, especially in children who are refractory to medical therapy or develop complex GCAA, are controversial. Given that coronary artery bypass grafting (CABG) is an important revascularization technique, its timing, indications, and long-term outcomes, especially the practical experience and results across different populations, require further elucidation. While currently available large-scale clinical evidence regarding CABG in children with KD primarily originates from Japan,[3] comprehensive multicenter summaries of related surgical treatment experience are lacking in China, although China is another region with a high incidence of KD. This gap limits the understanding of the unique clinical characteristics and intervention outcomes in this population. This study aimed to retrospectively analyze the clinical data of children with KD who had undergone CABG at five cardiac surgery centers in China. We specifically focused on the potential impact of GCAA on surgical strategies and prognosis to provide a reference for future clinical decision-making and research design. A retrospective analysis was conducted on patients from five cardiac surgery centers in China from March 2010 to August 2024 [Supplementary Table 1, https://links.lww.com/CM9/C825]. The study was approved by the leading Human Research Ethics Committee of Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine (SCMCIRB-K2024237-1). The requirement for informed consent was waived by the ethics committee due to the retrospective nature of the study. All of the patients had a prior diagnosis of KD-associated coronary artery disease and had undergone CABG. Significant coronary artery stenosis accompanied by clinical signs of myocardial ischemia was the indication for surgical intervention in these cases.[3] Myocardial ischemia was defined as electrocardiographic evidence of abnormal ventricular wall motion, abnormal Q waves, or ST-segment changes, or atrial fibrillation, accompanied by severe valvular regurgitation, and a left-ventricular ejection fraction (LVEF) below 50%. Based on the presence or absence of GCAA, the patients were divided into the GCAA group and the non-GCAA group. The primary outcomes included major adverse cardiovascular events, graft patency, and manifestations of myocardial ischemia during follow-up. Continuous variables were analyzed using Student’s t-test for normally distributed data or the Mann–Whitney U test for non-normally distributed data, with results presented as mean ± standard deviation (SD) or median (interquartile range [IQR]), respectively. Categorical variables were expressed as numbers (percentages) and compared using the chi-squared test or Fisher’s exact test. A Cox regression model was applied to investigate potential influencing factors for myocardial ischemia during the follow-up period. Variables in the model were expressed as hazard ratios (HRs) with their 95% confidence intervals (CIs). All analyses were performed using SPSS Statistics 25.0 (IBM, Chicago, IL, USA), and a two-sided P-value