Ozaki S, Toyama M, Ohashi T, Kawase I, Sekiguchi S, Horimi H
Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Nov;44(11):1969-75.
We have operated upon 30 cases of coronary reoperation during the past 12 years. The mean interval between the two operations was 46 months. The mean follow-up after reoperation was 61 months. The major reasons for reoperation were graft failure from technical problems in early and time-related degeneration in graft and native coronary progression in late cases. We aggressively have replaced the stenotic and obstructed vein graft with the arterial graft at reoperation since 1990. Hypoperfusion syndrome is clinical entity reported secondary to inadequate flow via the internal thoracic artery. For patients with atherosclerotic vein grafts to the LAD, the minimal manipulation of the old vein graft, adding the IMA graft to the LAD and leaving the stenotic vein graft intact appear to be safe and better procedure for long-term results. There were no operative and hospital death. Five and 10 years survival rate were 100% and 90% respectively. Five and 10 years event free rate were 92.1% and 82.9% respectively. The outcome of reoperation was satisfactory.
在过去12年里，我们对30例患者进行了冠状动脉再次手术。两次手术之间的平均间隔时间为46个月。再次手术后的平均随访时间为61个月。再次手术的主要原因包括早期技术问题导致的移植血管失败、移植血管与时间相关的退化以及后期自身冠状动脉病变进展。自1990年以来，我们在再次手术时积极地用动脉移植血管替换狭窄和阻塞的静脉移植血管。低灌注综合征是一种临床病症，据报道继发于胸廓内动脉血流量不足。对于左前降支有动脉粥样硬化静脉移植血管的患者，尽量减少对旧静脉移植血管的操作、将胸廓内动脉移植到左前降支并保持狭窄静脉移植血管完整，似乎是一种安全且长期效果更好的手术方法。没有手术死亡和住院死亡病例。5年和10年生存率分别为100%和90%。5年和10年无事件发生率分别为92.1%和82.9%。再次手术的结果令人满意。
