Nakayama Taisuke, Nakayama Mayuko, Harada Takashi, Isshiki Shingo, Sasaki Hideki, Ishitoya Hiroshi
Department of Cardiovascular Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Kyobu Geka. 2017 Dec;70(13):1111-1114.
A 61-year-old man was admitted because of unstable angina. The patient had a history of CABG [LITA-left anterior descending artery(LAD), aorta-saphenous vein graft(SVG)-posterolateral branch (PL)-diagonal branch (D1)]4 years ago. Coronary angiography revealed an occlusion of old SVG at proximal anastomosis site and a stenosis of native high lateral artery (HL). To reduce the risk of cardiac injury and damage to the patent grafts due at sternal reentry, we performed redo CABG through left thoracotomy. The proximal site of SVG was anastomosed to descending aorta using automated proximal anastomosis system. The SVG was anastomosed to the HL and old SVG in a sequential mode. Postoperative course was uneventful and the patient was discharged on postoperative day 14. Redo CABG through left thoracotomy provides safe and effective surgical approach in patient who requires revascularization of left circumflex territory.
一名61岁男性因不稳定型心绞痛入院。该患者4年前有冠状动脉旁路移植术病史[左内乳动脉-左前降支（LAD）、主动脉-大隐静脉移植血管（SVG）-后外侧支（PL）-对角支（D1）]。冠状动脉造影显示旧的SVG在近端吻合口处闭塞，以及自身高位外侧动脉（HL）狭窄。为降低因再次开胸导致心脏损伤和对通畅移植血管造成损害的风险，我们通过左胸切口进行再次冠状动脉旁路移植术。使用自动近端吻合系统将SVG的近端吻合至降主动脉。SVG以序贯方式吻合至HL和旧的SVG。术后过程顺利，患者于术后第14天出院。通过左胸切口进行再次冠状动脉旁路移植术为需要对左旋支区域进行血运重建的患者提供了安全有效的手术方法。
