Department of Cardiovascular Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 564-8565, Japan.
Surg Today. 2021 Sep;51(9):1464-1470. doi: 10.1007/s00595-021-02246-0. Epub 2021 Feb 19.
A coronary artery aneurysm (CAA) can result in critical cardiac events such as thromboembolic complications or rupture. A saccular CAA located in the left main trunk (LMT) is the most critical form of this pathology and its surgical repair is challenging. We conducted this single-center study to review the surgical outcomes of patients with a saccular CAA in the LMT.
Between May, 2012 and June, 2020, five patients with a saccular CAA in the LMT underwent surgery at our center. The median age at operation was 66.5 (59.7-69) years and the median diameter of the CAA was 13.0 mm (IQR 11-14 mm).
The CAA was fully excluded by patch closure of the LMT orifice and direct closure of the distal LMT, supplemented by coronary artery bypass grafting with the exclusive use of arterial conduits. There was no in-hospital mortality, although one patient suffered graft spasm-related myocardial infarction with complete recovery. Post-operative angiography showed a fully excluded LMT in all patients. There was no mortality or adverse cardiac events during follow-up.
Our surgical policy for CAA in the LMT is feasible and safe; however, coronary blood flow is dependent on reliable bypasses.
冠状动脉瘤（CAA）可导致严重的心脏事件，如血栓栓塞并发症或破裂。位于左主干（LMT）的囊状 CAA 是这种病理的最严重形式，其手术修复具有挑战性。我们进行了这项单中心研究，以回顾 LMT 中囊状 CAA 患者的手术结果。
2012 年 5 月至 2020 年 6 月，我们中心对 5 例 LMT 中囊状 CAA 患者进行了手术。手术时的中位年龄为 66.5（59.7-69）岁，CAA 的中位直径为 13.0mm（IQR 11-14mm）。
通过补片封闭 LMT 口和直接封闭 LMT 远端，同时仅使用动脉移植物进行冠状动脉旁路移植术，完全排除了 CAA。尽管 1 例患者发生了与移植血管痉挛相关的心肌梗死，但完全恢复，没有院内死亡。术后血管造影显示所有患者的 LMT 均完全排除。随访期间无死亡或不良心脏事件。
我们对 LMT 中 CAA 的手术策略是可行和安全的；然而，冠状动脉血流依赖于可靠的旁路。
