Pediatric Coronary Artery Bypass Grafting: Surgical Innovations, Challenges, and Future Directions

Abstract

Pediatric coronary artery bypass grafting (CABG) is a rare but life-saving intervention for children with complex coronary pathologies, including congenital anomalies, Kawasaki disease, and iatrogenic injuries. Unlike adult CABG, pediatric cases present unique challenges due to small vessel anatomy, growth considerations, and diverse etiologies, necessitating specialized surgical and perioperative strategies. This review addresses the critical need for synthesizing current evidence to guide clinicians in optimizing outcomes for these vulnerable patients. The review highlights key insights, including the superiority of the internal thoracic artery (ITA) as a conduit for its long-term patency and growth adaptability, while acknowledging limitations of alternative grafts. It explores evolving techniques such as off-pump CABG, hybrid revascularization, and microsurgical advancements tailored to pediatric anatomy. Perioperative management, including anesthetic considerations and antiplatelet therapy, is emphasized as pivotal for reducing complications. Clinical studies demonstrate promising short- and mid-term outcomes, though graft durability and reintervention risks warrant further investigation. The review also underscores the importance of multidisciplinary collaboration and centralized care in low-volume, high-complexity cases. Finally, it identifies gaps in standardized protocols and the need for robust long-term follow-up data. Future research should prioritize multicenter studies to establish evidence-based guidelines and refine surgical techniques for pediatric CABG. Innovations in conduit technology, imaging, and personalized pharmacologic regimens hold promises for improving graft longevity and patient survival. By addressing these gaps, the field can advance toward safer, more effective revascularization strategies that ensure children with coronary pathologies achieve optimal long-term outcomes.