Nishida H, Tomizawa Y, Endo M, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Kyobu Geka. 1999 Jul;52(8 Suppl):688-92.
Between August 1987 and November 1998, 137 patients underwent emergency CABG within 24 hours from the notification of cardiologist. Among them, 37 patients (27%) (34 men, 3 women) with a mean age of 59.9 (range, 39-76) underwent multiple CABG with exclusive use of arterial conduits. Preoperative diagnosis was acute myocardial infarction in 20 patients and unstable angina in 17 patients. Twenty-nine patients (78%) had either triple vessel or left main disease. There were 3 redo CABG and 3 patients were on hemodialysis. Postoperative follow-up averaged 44 months. Twenty-nine patients (78%) were under IABP support preoperatively. The mean number of anastomoses was 2.65 (range, 2-5). One patient (2.7%) died of persistent heart failure 54 days postoperatively. The patency was confirmed angiographically in 33 patients 3-4 weeks after surgery. Overall patency was 90.6% (LITA: 93.0%, RGEA: 76.2%, RITA, radial: 100%). There were no late deaths or redo CABG, and 2 patients sustained myocardial infarction and 3 patients underwent PTCA during follow-up. Five-year actuarial survival rate was 97.1% and cardiac event-free rate was 75.7%. These excellent early and long-term results suggest that complete arterial grafting for emergency CABG should be considered as a primary treatment in patients who have multivessel or left main disease, and no ongoing profound cardiogenic shock or rapid deterioration.
1987年8月至1998年11月期间，137例患者在心脏病专家通知后的24小时内接受了急诊冠状动脉旁路移植术（CABG）。其中，37例患者（27%）（34例男性，3例女性）平均年龄59.9岁（范围39 - 76岁）接受了仅使用动脉血管移植物的多次CABG。术前诊断为急性心肌梗死20例，不稳定型心绞痛17例。29例患者（78%）患有三支血管病变或左主干病变。有3例再次CABG，3例患者接受血液透析。术后随访平均44个月。29例患者（78%）术前接受主动脉内球囊反搏（IABP）支持。平均吻合口数量为2.65个（范围2 - 5个）。1例患者（2.7%）术后54天死于持续性心力衰竭。术后3 - 4周，33例患者经血管造影证实血管通畅。总体通畅率为90.6%（左内乳动脉：93.0%，右胃网膜动脉：76.2%，右内乳动脉、桡动脉：100%）。随访期间无晚期死亡或再次CABG，2例患者发生心肌梗死，3例患者接受经皮冠状动脉腔内血管成形术（PTCA）。五年精算生存率为97.1%，无心脏事件发生率为75.7%。这些优异的早期和长期结果表明，对于患有多支血管病变或左主干病变且无持续性严重心源性休克或快速病情恶化的患者，急诊CABG的完全动脉血管移植应被视为主要治疗方法。
