Abstract
Current strategies for pediatric coronary artery bypass surgery have been better clarified through the accumulation of experience and data: 1) Long-term survival rates following pediatric coronary bypass surgery utilizing internal thoracic artery (ITA) grafts are promising, with reported survival rates of 95% up to 40 years post-surgery for patients with Kawasaki disease complications and > 75% for those undergoing coronary transfer operations up to 20 years post-surgery. 2) Bilateral use of ITA grafts in small children can be performed safely and effectively, even during infancy. 3) The increase in the blood supply capacity of ITA grafts occurs more rapidly and effectively than previously thought, allowing for their use in emergency situations involving acute coronary events. 4) Tightening or ligation of the coronary artery distal to the aneurysm combined with ITA grafting to the distal coronary artery can prevent flow competition with careful intraoperative monitoring and care; however, further evidence is needed to establish a definitive surgical strategy. 5) The use of surgical microscopes in pediatric coronary bypass surgery for infants and small children is now accepted by cardiac surgeons.
