Shiraishi Y, Miyamoto T, Shimada I, Pak C, Shinkura N, Ohno N
Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Sep;39(9):1821-4.
From January, 1984 to May, 1990 eleven patients (men 9, women 2) underwent coronary artery bypass surgery for chronic total occlusion of the left main coronary artery by means of intermittent antegrade cold blood cardioplegia. The ages ranged from 33 to 74 (mean 56) years. The causes of the total occlusion of the left main coronary artery were atherosclerosis in 10 patients and aortitis syndrome in one. Four patients had history of a previous myocardial infarction. Preoperative selective coronary arteriography revealed well developed collateral vessels from the RCA to the LCA in all patients. One to five coronary arteries were bypassed. Myocardial protection was obtained in the usual fashion: antegrade intermittent cold blood cardioplegia with topical cardiac cooling. All patients were successfully weaned off from cardiopulmonary bypass without the need of IABP assist. No patient developed perioperative myocardial infarction. All grafts were patent postoperatively. Treadmill testing was negative in all patients. We believe that coronary artery bypass surgery for chronic total occlusion of the left main coronary artery can be performed safely with intermittent antegrade cold blood cardioplegia.
1984年1月至1990年5月，11例患者（男性9例，女性2例）因左冠状动脉主干慢性完全闭塞接受了冠状动脉搭桥手术，采用间歇性顺行冷血心脏停搏法。年龄范围为33至74岁（平均56岁）。左冠状动脉主干完全闭塞的原因是10例患者为动脉粥样硬化，1例为主动脉炎综合征。4例患者有既往心肌梗死病史。术前选择性冠状动脉造影显示所有患者均有从右冠状动脉到左冠状动脉的良好侧支血管。搭桥1至5支冠状动脉。以常规方式进行心肌保护：顺行间歇性冷血心脏停搏并局部心脏降温。所有患者均成功脱离体外循环，无需主动脉内球囊反搏辅助。无患者发生围手术期心肌梗死。所有移植物术后均通畅。所有患者的跑步机测试均为阴性。我们认为，采用间歇性顺行冷血心脏停搏法可安全地进行左冠状动脉主干慢性完全闭塞的冠状动脉搭桥手术。
