Higami T, Ogawa K, Asada T, Mukohara N, Nishiwaki M, Sugimoto T, Okada K, Kawamura T
Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Jul;40(7):1071-7.
Patients with poor left ventricular function or those requiring urgent surgery may have more extensive ischemic myocardial injury if myocardial preservation is incomplete. We have performed coronary artery bypass grafting (CABG) aimed at complete revascularization in such cases using RC-CBCP, which is considered more effective on myocardial preservation during aortic cross-clamping in particular to protect ischemic area distal to severe coronary artery stenosis or obstruction. In the present study, in 25 patients with poor left ventricular function (left ventricular ejection fraction; LVEF less than or equal to 0.3) including 10 patients who required urgent surgery, the operative results were evaluated. All the distal and proximal anastomoses of grafts (average 2.5 grafts) were completed during one aortic cross-clamping using RC-CBCP, therefore graft flow was obtained immediately after release of the aortic clamping. Though this method required 142 minutes of a mean aortic cross-clamping time, myocardial protection was considered to be preferable judging from postoperative isoenzymatic evaluation and improved ventricular function. Fifteen patients with elective CABG were all alive and restored to NYHA class I to II. Among 10 patients requiring urgent CABG, 4 patients with acute myocardial infarction died but others were restored to NYHA class I to II. We conclude that it is important to aim at complete coronary revascularization in patients with poor left ventricular function and RC-CBCP achieves more effective myocardial protection during CABG in the patients.
左心室功能不佳的患者或需要紧急手术的患者，如果心肌保护不完整，可能会有更广泛的缺血性心肌损伤。我们针对此类病例使用遥控冠状动脉搭桥术（RC-CBCP）进行冠状动脉搭桥术（CABG），旨在实现完全血运重建，该方法在主动脉交叉钳夹期间对心肌保护更有效，特别是可保护严重冠状动脉狭窄或阻塞远端的缺血区域。在本研究中，对25例左心室功能不佳（左心室射血分数；LVEF小于或等于0.3）的患者进行了手术结果评估，其中包括10例需要紧急手术的患者。使用RC-CBCP在一次主动脉交叉钳夹期间完成了所有移植物的远端和近端吻合（平均2.5个移植物），因此在松开主动脉钳夹后立即获得了移植物血流。虽然该方法平均主动脉交叉钳夹时间需要142分钟，但从术后同工酶评估和改善的心室功能来看，心肌保护被认为是较好的。15例择期CABG患者均存活并恢复至纽约心脏协会（NYHA）I级至II级。在10例需要紧急CABG的患者中，4例急性心肌梗死患者死亡，但其他患者恢复至NYHA I级至II级。我们得出结论，对于左心室功能不佳的患者，旨在实现完全冠状动脉血运重建很重要，并且RC-CBCP在CABG期间对这些患者可实现更有效的心肌保护。
