Takahashi K, Daitoku K, Minakawa M, Kondo N
Department of Cardiovascular Surgery, Aomori Rosai Hospital, Hachinohe, Japan.
Kyobu Geka. 2003 Jul;56(8 Suppl):650-5.
In off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) procedures involving multiple vessels, the Aorta No-Touch technique is increasingly being adopted to avoid cerebral infarction, while gastro-epiploic artery (GEA)-left anterior descending coronary artery branch (LAD) anastomosis or composite T-grafting is performed to supply blood to multiple coronary arteries through the left internal thoracic artery (LITA) as an inflow conduit. The objective of the present study is to investigate the effectiveness and advisability of grafting in patients who undergo OPCAB involving multiple vessels, including those who undergo standard CABG. CONCLUSIONS 1: Composite T-grafts of the LITA in OPCAB involving multiple vessels can present certain problems with patency, patient survival, and need for subsequent revision procedures. In the event of a graft failure, serious symptoms resembling left main coronary trunk (LMT) may develop. 2: The incidence of cardiac events with GEA-LAD is high, and patency in the distal phase is poor. 3: Ideally, LITA-LAD should be performed alone. 4: Among patients who have been screened before the procedure, satisfactory results are obtained for OPCAB in which the ascending aorta serves as an inflow conduit; this procedure should be considered as a viable option.
在涉及多支血管的非体外循环冠状动脉旁路移植术（非体外循环冠状动脉搭桥术：OPCAB）中，越来越多地采用主动脉免接触技术以避免脑梗死，同时进行胃网膜动脉（GEA）-左前降支冠状动脉分支（LAD）吻合术或复合T型移植术，通过左胸廓内动脉（LITA）作为流入管道为多支冠状动脉供血。本研究的目的是调查在接受包括标准冠状动脉搭桥术患者在内的多支血管OPCAB患者中进行移植的有效性和可取性。结论1：在涉及多支血管的OPCAB中，LITA的复合T型移植在通畅性、患者生存率和后续翻修手术需求方面可能存在某些问题。如果移植失败，可能会出现类似于左主干冠状动脉（LMT）的严重症状。2：GEA-LAD的心脏事件发生率高，远期通畅性差。3：理想情况下，应单独进行LITA-LAD。4：在术前经过筛选的患者中，以升主动脉作为流入管道的OPCAB可获得满意结果；该手术应被视为一种可行的选择。
