1. INTRODUCTION
Kawasaki disease (KD) is a systemic inflammatory condition occurring
predominantly in children (80% of patients are younger than 5 years of
age), first reported in 1974 as an acute febrile illness with
muco-cutaneous lesions and lymphadenopathy [1, 2]. The incidence of
KD varies across the world from 19 to 265 cases per 100,000 in children
less than 5 years of age [2]. It can be complicated by a systemic
vasculitis with particular involvement of the coronary arteries, if left
untreated 20% of children could develop coronary artery aneurysm
[2]. In the acute phase of the disease inflammatory formation of
coronary aneurysms can occur, eventually associated with rupture of the
latter, while thrombosis or narrowing of the affected coronary arteries
can complicate the late phases [2-6]. In high income countries KD
remains the leading cause of acquired heart disease in children, with
complication such as acute myocardial infarction [2, 7-9]. Despite
extraordinary results due to early recognition of the disease and
treatment with intra-venous administration of immunoglobulins [2,
10], long-term studies showed that complications secondary to
inflammation and aneurysmatic dilatation of the coronary arteries can
still occur, with subsequent impairment of the left ventricular function
[2, 8, 9, 11-14]. Selective coronary angiography is indispensable in
those situations to provide essential information for the decision
making, before percutaneous or surgical myocardial revascularization
[2, 14-17]. Coronary artery bypass graft (CABG) is performed in the
presence of inflammation and aneurysms of the coronary arteries, using
both arterial and/or venous grafts [17, 18]. In literature only
retrospective studies about CABG after KD are found and no meta-analysis
has been published until now: grafts’ patency and long-term outcomes
such as survival rates appear uncertain. Since the risk of progression
of the systemic arteritis with formation of aneurysms in other arterial
districts [19], such as internal thoracic artery (ITA) [20], the
choice of the best type of surgical revascularization is still a matter
of discussions [18].
The objectives of our study were to assess which surgical strategy of
CABG provides better graft patency and short and long-term outcomes,
through a literature systematic review and a Bayesian network
meta-analysis. A PICOS study design was displayed in Supplementary Table
1. Primary endpoint is graft patency for ITAs, saphenous veins (SV) and
other conduits (gastroepiploic [GEA] and radial [RA] arteries).
Secondary endpoints were early mortality, need for interventional
procedures and surgical re-interventions, and long-term mortality for
arterial, venous or mixed (arterial plus second venous graft) types of
revascularization.