左前下行枝の重複病変に対する Off-Pump Onlay Bypass Grafting の有用性  [in Japanese] 6 Cases Report : Off-Pump Onlay Bypass Grafting of Multiple Diseased Left Anterior Descending Coronary Artery Using Internal Thoracic Artery  [in Japanese]

【背景】近年のカテーテルインターベンションの発達に伴い,多枝病変に対する冠動脈バイパス術(CABG)が増加しつつある.その中には同一冠動脈内に重複した狭窄病変を有するために単純なCABGでは対処しえない症例が認められる.【目的】左前下行枝(LAD)の重複病変に対してOnlay Bypass Graftingの有用性を検討すること.【結果】2005年1月~2007年7月まで当院で施行したOff-Pump CABG症例(131例)の内,6症例でLADの重複病変に対してOnlay Bypass Graftingを行った.年齢68.8±6.5歳,性別 男:女＝5:1,Bypass枝数 2.1±0.9,術後最高CPK-MB 32.8±29.8IU/L,On-Pump Conversion 0%(0/6),PMI発生率 0%(0/6),Graft開存率 100%(5/5)であった.【結論】Off-pump Onlay Bypass Graftingを左前下行枝重複病変に対し行い,結果は良好であった.Onlay Bypass Graftingは左前下行枝分枝の完全血行再建を目指す,有用な治療法であると考えられた.

Background: Off-pump onlay bypass grafting has shown to be beneficial in patient with multiply diseased left anterior descending coronary arteries from the aspect of complete revascularization. We would like to present our 6 experiences and valuate expediency of Off-pump onlay bypass grafting. On our method, internal thoracic arteries were bypassed to diseased LAD of all 6 patients. Result: There were five males and one female with mean age of 68.8±6.5 years. Four patients had developed stable angina pectoris. The other two patients had developed unstable angina pectoris with usage of intra-aortic balloon pump (IABP). None of the procedures were converted to on-pump coronary artery bypass grafting (CABG). Mean postoperative CPK-MB (max) was 32.8±29.8IU/l, and no patient had perioperative myocardial infarction. Early patency of grafts was assessed by multi-detector CT (MDCT). Five of 6 patients were administered MDCT. One was not administered MDCT because of chronic renal failure. Early patency rate was 100% (5/5). There was no early death and angina symptom. Mean hospital stay was 33.3±15.3 days. Conclusion: Off-pump onlay bypass grafting for multiple diseased left anterior descending coronary arteries seems to be a very useful procedure.