Kawaue Y, Nakao T
Department of Cardiovascular Surgery, Koseiren Hiroshima General Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Dec;40(12):2144-9.
Although increasing use is being made of arterial grafts (internal thoracic arteries and right gastroepiploic artery) for coronary revascularization, application to left main coronary artery (LMT) patients is frequently not possible. During the period from December 1989 to July 1991, coronary revascularization was conducted on 9 LMT patients using only arterial grafts and no venous grafts. The bypass grafts were 6 left internal thoracic artery grafts, 9 right internal thoracic artery grafts and 9 right gastroepiploic artery grafts, a total of 24 grafts and an average of 2.7 bypasses per patient. There were no operated deaths, but five patients required IABP support after cardiopulmonary bypass. They had more than 90% stenotic lesions of left main coronary artery. In contrast, four patients with less than 90% stenotic lesion were uneventful. The cause of these catastrophic hemodynamics was considered reduced blood flow by graft spasm. All patients could be functionally placed in New York Heart Association Class I or II. Postoperative stress tests were made on eight patients and the results were normal in seven. Eight patients have had postoperative angiograms. Twenty-one of 22 grafts were patent. The present results demonstrate that an arterial bypass is possible even on LMT patients by IABP support.
尽管动脉移植物（胸廓内动脉和右胃网膜动脉）在冠状动脉血运重建中的应用越来越多，但对于左冠状动脉主干（LMT）患者，往往无法应用。在1989年12月至1991年7月期间，对9例LMT患者仅使用动脉移植物而未使用静脉移植物进行了冠状动脉血运重建。搭桥移植物包括6例左胸廓内动脉移植物、9例右胸廓内动脉移植物和9例右胃网膜动脉移植物，共24根移植物，平均每位患者2.7条旁路。无手术死亡病例，但5例患者在体外循环后需要主动脉内球囊反搏（IABP）支持。他们的左冠状动脉主干狭窄病变超过90%。相比之下，4例狭窄病变小于90%的患者情况平稳。这些灾难性血流动力学的原因被认为是移植物痉挛导致血流减少。所有患者在功能上均可归为纽约心脏协会I级或II级。对8例患者进行了术后应激试验，7例结果正常。8例患者进行了术后血管造影。22根移植物中有21根通畅。目前的结果表明，即使是LMT患者，通过IABP支持也可以进行动脉搭桥。
