Kawasaki disease surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2];Arzu Kalayci, M.D. [3]

Overview

Mechanical revascularization may be attempted in patients with coronary artery compromise.

Surgery

Recommendations for Indications for Mechanical Revascularization[1]
Class I
"1. Adult patients with remote history of KD presenting with STEMI should be referred emergently for coronary angiography for determination of best means of flow restoration in the culprit artery.(Level of Evidence: C) "
"2. Revascularization should be performed in KD patients with stable angina and high-risk coronary anatomy including left main CAD, multi- vessel coronary disease with reduction in LV function, multivessel coronary disease with diabetes mellitus, or high-risk noninvasive ischemia testing.(Level of Evidence: C) "
"3. Revascularization should be performed for patients with non–ST-segment elevation and coronary anatomy amenable to revascularization on coronary angiography.(Level of Evidence: C) "
Class IIa
"1. Revascularization for patients with stable angina and symptoms refractory to maximal medical therapy is reasonable. (Level of Evidence: C) "
Class IIb
"1. Revascularization for KD patients with silent ischemia and ischemia involving >10% of LV mass may be considered. (Level of Evidence: C) "
Class III
"1. Revascularization should be avoided in KD patients in the acute/subacute phase of the illness with STEMI attributable to acute thrombotic occlusion of an aneurysm.(Level of Evidence: C) "
Recommendations for Modes of Revascularization[2]
Class I
"1. CABG is preferred to PCI in KD patients with left main CAD, multivessel CAD with reduced LV function, multivessel CAD with lesions not amenable to PCI, and multivessel CAD in diabetic patients.(Level of Evidence: B) "
"2. CABG is preferred to PCI in older children and adults with KD and multivessel involvement .(Level of Evidence: C) "
"3. CABG should be performed with bilateral internal thoracic arterial grafts where possible.(Level of Evidence: B) "
"4. PCI is preferred in patients with single-vessel or focal multivessel disease amenable to PCI.(Level of Evidence: C) "
"5. RA and stents should be used in PCI of calcified lesions.(Level of Evidence: C) "
Class IIa
"1. The use of multivessel PCI is reasonable for KD patients with focal lesions amenable to PCI. (Level of Evidence: C) "
"2. The use of DESs during PCI is reasonable for KD patients who do not require long- term anticoagulation. (Level of Evidence: C) "
"3. The use of IVUS is reasonably indicated during PCI in KD patients to ensure adequate stent sizing and deployment. (Level of Evidence: C) "
Class IIb
"1. Multivessel PCI may be considered for patients who are acceptable CABG candidates but prefer to avoid CABG, provided the risks and benefits of both approaches are discussed with and understood by the patient. (Level of Evidence: C) "
"2. The use of DESs during PCI may be considered for KD patients who require anti- coagulation, provided the bleeding risk of the patient is acceptable. (Level of Evidence: C) "
Class III
"1. Stand-alone balloon angioplasty should not be used for PCI in KD patients with coronary obstructions.(Level of Evidence: C) "
Recommendation for Cardiac Transplantation[3]
Class IIa
"1. The use of multivessel PCI is reasonable for KD patients with focal lesions amenable to PCI. (Level of Evidence: C) "

References

  1. McCrindle, Brian W.; Rowley, Anne H.; Newburger, Jane W.; Burns, Jane C.; Bolger, Anne F.; Gewitz, Michael; Baker, Annette L.; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B.; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T.; Pahl, Elfriede (2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. ISSN 0009-7322.
  2. McCrindle, Brian W.; Rowley, Anne H.; Newburger, Jane W.; Burns, Jane C.; Bolger, Anne F.; Gewitz, Michael; Baker, Annette L.; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B.; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T.; Pahl, Elfriede (2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. ISSN 0009-7322.
  3. McCrindle, Brian W.; Rowley, Anne H.; Newburger, Jane W.; Burns, Jane C.; Bolger, Anne F.; Gewitz, Michael; Baker, Annette L.; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B.; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T.; Pahl, Elfriede (2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. ISSN 0009-7322.

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