Yokoyama Yasutaka, Kuwaki Kenji, Amano Atsushi
Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Kyobu Geka. 2013 Jul;66(8 Suppl):611-7.
Redo-coronary artery bypass grafting( redo-CABG) still remains a challenging operation and is associated with a significantly higher risk of morbidity and mortality when compared with primary CABG. The higher risk of redo-CABG is largely attributable to the increased technical difficulty and the greater incremental risk in redo-CABG patients. Annual reports by the Japanese Association for Thoracic Surgery in recent years reveled that the absolute and relative number of redo-CABG gradually decreased, and in-hospital mortality did not change significantly over this periods and was much higher than primary CABG. The increasing use of percutaneous coronary intervention (PCI) for previous CABG patients could be a reason for the decrease of redo-CABG, and therefore surgery of redo-CABG is becoming more limited. This paper presents the current indications, safe surgical technique, and perioperative management of redo-CABG patients, as well as the contemporary results of redo-CABG in our institution.
再次冠状动脉旁路移植术(redo-CABG)仍然是一项具有挑战性的手术,与初次CABG相比,其发病和死亡风险显著更高。redo-CABG的较高风险很大程度上归因于技术难度增加以及redo-CABG患者的额外风险更大。近年来日本胸外科学会的年度报告显示,redo-CABG的绝对数量和相对数量逐渐减少,在此期间住院死亡率没有显著变化,且远高于初次CABG。对既往CABG患者越来越多地使用经皮冠状动脉介入治疗(PCI)可能是redo-CABG减少的一个原因,因此redo-CABG手术的应用越来越有限。本文介绍了redo-CABG患者的当前适应证、安全的手术技术和围手术期管理,以及我们机构redo-CABG的当代结果。