Kawasaki disease surgery: Difference between revisions

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Revision as of 13:58, 10 April 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Indications

Recommendations for Modes of Revascularization

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) "

References

Template:WH Template:WS

@@ Line 23: / Line 23: @@
 ==Indications==
+=====Recommendations for Modes of Revascularization=====
-*Surgical intervention is not recommended for the management of [disease name].
+{| class="wikitable" style="width:80%"
-OR
+|-
-*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
+| style="text-align:center; background:LightGreen" colspan="1" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
-**[Indication 1]
+|-
-**[Indication 2]
+| bgcolor="lightgreen" |<nowiki>"</nowiki>'''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.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
-**[Indication 3]
+|-
-*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
+| bgcolor="lightgreen" |<nowiki>"</nowiki>'''2.''' CABG is preferred to PCI in older children and adults with KD and multivessel involvement .''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
-**[Indication 1]
+|-
-**[Indication 2]
+| bgcolor="lightgreen" |'''<nowiki>"</nowiki>3.''' CABG should be performed with bilateral internal thoracic arterial grafts where possible.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
-**[Indication 3]
+|-
+| bgcolor="lightgreen" |<nowiki>"</nowiki>'''4.''' PCI is preferred in patients with single-vessel or focal multivessel disease amenable to PCI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="lightgreen" |<nowiki>"</nowiki>'''5.''' RA and stents should be used in PCI of calcified lesions.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| style="text-align:center; background:LemonChiffon" colspan="1" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+|-
+| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''1.''' The use of multivessel PCI is reasonable for KD patients with focal lesions amenable to PCI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''2.''' The use of DESs during PCI is reasonable for KD patients who do not require long- term anticoagulation. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''3.''' The use of IVUS is reasonably indicated during PCI in KD patients to ensure adequate stent sizing and deployment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| style="text-align:center; background:LemonChiffon" colspan="1" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
+|-
+| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| style="text-align:center; background:LightCoral" colspan="1" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
+|-
+| bgcolor="lightcoral" |<nowiki>"</nowiki>'''1.''' Stand-alone balloon angioplasty should not be used for PCI in KD patients with coronary obstructions.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|}
-==Surgery==
-*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
-OR
-*Surgery is the mainstay of treatment for [disease or malignancy].
-==Contraindications==
 ==References==