Kigawa I, Suma H, Nishimi M, Horii T, Fukuda S, Wanibuchi Y
Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Apr;42(4):603-6.
A 75-year-old female who had underwent coronary artery bypass grafting (CABG) reoperation 2 years before was readmitted because of unstable angina. Two arterial grafts and one saphenous vein graft (SVG) were all occluded one and half year after the primary operation. The second operation was approached via the repeated sternotomy. LAD and RCA were revascularized with a Y-shaped SVG which had only one inflow. Coronary angiogram revealed stenosis of LMT and RCA and occlusion of the inflow of the Y-shaped SVG. We performed the 3rd CABG via the left thoracotomy without cardiopulmonary bypass for revascularization of the LAD area. A new SVG was anastomosed from the descending aorta to the old SVG just proximal to the anastomotic site with LAD. Local coronary occlusion time was 7 min without any hemodynamic or electrocardiographic deteriorations. The operation was successfully performed in 3 hr 55 min. The patient recovered well uneventfully. Postoperative angiogram showed that the new SVG was adequately patent and she was discharged without angina. We conclude that CABG without cardiopulmonary bypass via the left thoracotomy is an useful alternative to decrease mortality and morbidity for reoperative myocardial reveascularization.
一名75岁女性，两年前接受了冠状动脉旁路移植术（CABG）再次手术，因不稳定型心绞痛再次入院。初次手术后一年半，两根动脉移植物和一根大隐静脉移植物（SVG）均闭塞。第二次手术通过再次胸骨切开术进行。左前降支（LAD）和右冠状动脉（RCA）通过仅具有一个流入端的Y形SVG进行血运重建。冠状动脉造影显示左主干（LMT）和RCA狭窄以及Y形SVG流入端闭塞。我们通过左胸切口在非体外循环下进行了第三次CABG，以对LAD区域进行血运重建。一根新的SVG从降主动脉吻合至旧SVG，位于与LAD吻合部位的近端。局部冠状动脉闭塞时间为7分钟，未出现任何血流动力学或心电图恶化。手术在3小时55分钟内成功完成。患者恢复良好，过程顺利。术后血管造影显示新的SVG通畅良好，患者出院时无心绞痛症状。我们得出结论，通过左胸切口在非体外循环下进行CABG是一种有用的替代方法，可降低再次手术心肌血运重建的死亡率和发病率。
