冠状動脈バイパス再手術症例の治療戦略 ―LAST-MIDCABの有用性―

DOI 機関リポジトリ 被引用文献1件 参考文献27件

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タイトル別名
  • Surgical Strategy for Reoperative Coronary Artery Bypass Grafting.
  • 冠状動脈バイパス再手術症例の治療戦略　　ＬＡＳＴ‐ＭＩＤＣＡＢの有用性
  • LAST-MIDCABの有用性

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Though the number of reoperative coronary artery bypass grafting procedures (re-CABG) is increasing, the operative results are still inferior to primary CABG. In the present study, we analyzed results of our two different procedures for re-CABG and estimated predominance of the LAST-MIDCAB (off-pump left anterior small thoracotomy minimally invasive direct coronary artery bypass) procedure in selected patients. From 1999 to 2001, 25 patients underwent re-CABG. The age of patients ranged from 56 to 82 years (mean 70 years). Re-CABG was performed due to the occlusion of existing grafts in 14 cases, progressive disease of previously ungrafted vessels in 6 and anastomotic stenosis of previously grafted vessels in 5. We performed off-pump LAST-MIDCAB in 15 patients, on-pump CABG via a median sternotomy in 9 and on-pump LAST-CABG in 1 which was converted due to RV injury during a re-sternotomy. In the LAST-MIDCAB group, the left internal thoracic artery was chosen as a graft to the LAD in 10 patients, the right gastroepiploic artery in 4 and the saphenous vein in 1. The operation time of the LAST-MIDCAB group was significantly shorter than that of the on-pump CABG group. Blood transfusion was necessary for only one patient in the LAST-MIDCAB group. Although many postoperative complications occurred in the on-pump CABG group, no major postoperative complication was seen in the LAST-MIDCAB group except one patient who sufferred from lung fibrosis, which led to shortness of the postoperative hospital stay. We conclude that LAST-MIDCAB is an alternative way to reduce operative morbidity in selected re-CABG cases.

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