Coronary artery abnormalities in children that require bypass grafting are infrequent but represent a well-recognised entity with a broad spectrum of indications beyond Kawasaki disease. Although myocardial revascularisation in children is uncommon, studies have shown that it can yield favourable short- and long-term outcomes, allowing affected children to regain health and grow up to live normal lives.

Myocardial revascularisation in children is an extremely rare intervention in Western countries, accounting for less than 1% of all paediatric cardiac surgeries in this region. It is a highly technically demanding procedure that opens a new arena in cardiac surgery, for which cardiovascular surgeons need to be trained to achieve outcomes as good as those shown in the literature.

We present the experience of paediatric coronary artery bypass grafting in a middle-income country, with a wide range of indications.

A retrospective descriptive study was conducted on paediatric patients (under 18 years of age) who underwent coronary artery bypass grafting between 2004 and 2023 at a cardiovascular centre in Bogotá, Colombia. Data were collected from electronic medical records, including demographics, preoperative diagnoses, surgical details, and outcomes. Follow-up included clinical assessment and imaging with echocardiography. Ethical approval was obtained, and confidentiality was ensured.

Nine paediatric patients (ages 6–17) underwent coronary artery bypass grafting between 2004 and 2023. Kawasaki disease was the most common indication, but there are other aetiologies, including post-arterial switch coronary occlusion, anomalous origin of the LCA from the pulmonary artery, anomalous origin of coronary arteries from the aorta, Takayasu disease, and iatrogenic injury. The internal mammary artery was used in most cases, with successful completion of the planned revascularisation in all patients. There were no perioperative deaths or reinterventions. At a mean follow-up of 5.5 years, all patients showed clinical and biventricular improvement, and all grafts evaluated showed graft patency.

Paediatric coronary artery bypass grafting is a safe and effective treatment for selected congenital and acquired coronary pathologies, even in complex cases. Outcomes are optimised with the use of internal mammary arteries and a multidisciplinary heart team approach. In middle-income settings, favourable short- and mid-term results can be achieved despite follow-up challenges. Paediatric coronary artery bypass grafting should be considered a key component of congenital cardiac surgery training.