Bando M, Hirose H, Fuwa S, Mori Y, Murakawa S, Kumada Y, Takagi H, Furusawa Y, Azuma K
First Department of Surgery, Gifu University School of Medicine, Japan.
Kyobu Geka. 1995 Oct;48(11):933-6.
Among 172 cases of coronary artery bypass grafting, 9 cases (5%) revealed severely atherosclerotic ascending aorta. In 3 of the 9 cases, total aortic cross-clamping in the distal anastomoses of saphenous vein graft (SVG) and partial aortic clamp in the proximal anastomoses of SVG were performed. In 1 case with this technique, cerebral infarction was occurred. In 4 cases, total aortic cross-clamping in the distal and proximal anastomoses of SVG was performed. In 2 of these cases with this technique, cerebral infarctions were occurred. Hypothermic circulatory arrest was performed in 2 of the rest. In one case that was predicted to have atherosclerosis of ascending aorta prior to operation, the left internal thoracic artery was anastomosed to the left anterior descending, and SVG to the right coronary artery with hypothermia and ventricular fibrillation. And during the proximal anastomoses of SVG, hypothermic circulatory arrest without aortic clamping was initiated. In another case, atherosclerosis of ascending aorta was noted after aortic cross-clamping. Then the aorta was declamped, hypothermic circulatory arrest was established, the aorta was opened, the diseased segment was resected, and proximal anastomoses of SVG was performed to Dacron patch which was implanted for aortic wall. There were no cerebral infarction in last two patients.
在172例冠状动脉旁路移植术中，9例（5%）显示升主动脉严重粥样硬化。在这9例中的3例，在隐静脉移植物（SVG）远端吻合处进行了完全主动脉阻断，在SVG近端吻合处进行了部分主动脉钳夹。采用这种技术的1例发生了脑梗死。4例在SVG远端和近端吻合处均进行了完全主动脉阻断。采用这种技术的这些病例中有2例发生了脑梗死。其余病例中有2例进行了低温循环停搏。在1例术前预计有升主动脉粥样硬化的病例中，在低温及心室颤动下将左胸廓内动脉吻合至左前降支，将SVG吻合至右冠状动脉。在SVG近端吻合期间，启动了无主动脉钳夹的低温循环停搏。在另一例中，主动脉阻断后发现升主动脉粥样硬化。然后松开主动脉钳夹，建立低温循环停搏，打开主动脉，切除病变节段，并将SVG近端吻合至植入主动脉壁的涤纶补片。最后这2例患者均未发生脑梗死。
