Grondin C M, Pomar J L, Hébert Y, Bosch X, Santos J M, Enjalbert M, Campeau L
J Thorac Cardiovasc Surg. 1984 Mar;87(3):379-85.
Atherosclerotic changes are often noted in vein grafts at angiography 8 to 10 years after coronary artery grafting. Reoperation in these patients is hazardous, as manipulation of the grafts may loosen atheromatous debris and cause coronary embolization and myocardial infarction. A technique is described to avoid embolization of atheromatous material during reoperation in patients with patent atherosclerotic coronary vein grafts. This technique was carried out in six patients and compared to the standard technique of reoperation in similar patients. The incidence of complicated perioperative myocardial infarction (0/6 versus 5/12) and perioperative death (zero versus three) was lower when our new technique was used. This approach consists of minimal dissection for access to the right atrium and ascending aorta for cannulation, prompt ligation of all patent grafts at the start of cardiopulmonary bypass, cardioplegic infusion through the ascending aorta and subsequently also through newly inserted grafts using larger infusions until myocardial temperatures reach less than or equal to 15 degrees C, and single aortic clamping for distal and proximal anastomoses.
冠状动脉搭桥术后8至10年进行血管造影时，常可发现静脉移植物出现动脉粥样硬化改变。对这些患者进行再次手术风险很大，因为对移植物的操作可能会使动脉粥样硬化碎片脱落，导致冠状动脉栓塞和心肌梗死。本文描述了一种在患有动脉粥样硬化性冠状动脉静脉移植物且仍通畅的患者再次手术期间避免动脉粥样硬化物质栓塞的技术。该技术应用于6例患者，并与类似患者的标准再次手术技术进行了比较。采用我们的新技术时，围手术期并发心肌梗死（0/6比5/12）和围手术期死亡（0比3）的发生率较低。该方法包括为进入右心房和升主动脉进行插管而进行的最小限度解剖，在体外循环开始时迅速结扎所有通畅的移植物，通过升主动脉进行心脏停搏液灌注，随后也通过新插入的移植物使用较大剂量灌注直至心肌温度降至15℃及以下，以及进行单次主动脉阻断以进行远端和近端吻合。
