Manabe Susumu, Fukui Toshihiro, Miyajima Keisuke, Watanabe Yoshiyuki, Matsuyama Shigefumi, Shimokawa Tomoki, Takanashi Shuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahicho, Fuchu, Tokyo, Japan.
J Card Surg. 2009 Nov-Dec;24(6):644-9. doi: 10.1111/j.1540-8191.2009.00911.x.
There are many options for proximal anastomosis during off-pump coronary artery bypass grafting (CABG), but the efficacies of these procedures have not been well clarified. Therefore, we examined the clinical impact of our strategy to modify the proximal anastomosis procedure for aortic atherosclerosis.
We retrospectively reviewed 535 consecutive patients undergoing off-pump CABG between 2004 and 2007. The patients were divided into three groups depending upon the type of proximal anastomosis procedure: 241 patients with normal or mild atherosclerosis underwent partial clamping (clamp group), 81 patients with moderate atherosclerosis underwent the procedure with Heartstring (Guidant Corporation, Santa Clara, CA, USA), 28 patients underwent with Enclose II (Novare Surgical Systems, Inc., Cupertino, CA, USA) (device group), and 185 patients underwent the procedure without clamping, including six with severe atherosclerosis (no-touch group).
There were seven in-hospital mortalities (1.3%) and five strokes (0.9%). There was no difference in the mortality rate (clamp, 1.2%; device, 1.8%; no-touch, 1.1%; p = 0.42) or stroke rate (clamp, 0.8%; device, 2.8%; no-touch, 0.5%; p = 0.09) among the three groups. Graft patency was similar regardless of the method (clamp, 94.7%; Heartstring, 96.7%; Enclosed II, 96.0%; p = 0.80).
Our strategy to modify the proximal anastomosis procedure resulted in a low stroke rate. Aortic clamping could be performed safely in patients with normal or mild atherosclerotic aorta. In patients with moderate atherosclerosis, the result of an anastomotic device may need a further investigation.
在非体外循环冠状动脉旁路移植术（CABG）中，近端吻合有多种选择，但这些手术的疗效尚未得到充分阐明。因此，我们研究了我们改良近端吻合手术策略对主动脉粥样硬化的临床影响。
我们回顾性分析了2004年至2007年间连续接受非体外循环CABG的535例患者。根据近端吻合手术类型将患者分为三组：241例正常或轻度动脉粥样硬化患者接受部分阻断（阻断组），81例中度动脉粥样硬化患者采用Heartstring（美国加利福尼亚州圣克拉拉市Guidant公司）进行手术，28例患者采用Enclose II（美国加利福尼亚州库比蒂诺市Novare Surgical Systems公司）进行手术（器械组），185例患者未进行阻断进行手术，其中包括6例重度动脉粥样硬化患者（非接触组）。
有7例住院死亡（1.3%）和5例中风（0.9%）。三组之间的死亡率（阻断组，1.2%；器械组，1.8%；非接触组，1.1%；p = 0.42）或中风发生率（阻断组，0.8%；器械组，2.8%；非接触组，0.5%；p = 0.09）没有差异。无论采用何种方法，移植血管通畅率相似（阻断组，94.7%；Heartstring，96.7%；Enclosed II，96.0%；p = 0.80）。
我们改良近端吻合手术的策略导致中风发生率较低。对于正常或轻度主动脉粥样硬化的患者，可以安全地进行主动脉阻断。对于中度动脉粥样硬化患者，吻合器械的效果可能需要进一步研究。
