Okamura Y, Sugita Y, Mochizuki Y, Iida H, Mori H, Tabuchi K, Matsushita Y, Kobayashi S, Shimada K
Department of Thoracic and Cardiovascular Surgery, Dokkyo University, School of Medicine, Tochigi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 May;44(5):623-8.
Currently, cardioplegic arrest is used for almost all coronary artery bypass grafting (CABG). However, there are some cases in which aortic occlusion or the cardioplegic infusion is not desirable. In this paper, we discussed the indications and the usefulness of hypothermic fibrillatory arrest for CABG. From April 1992 to March 1995, CABG with hypothermic fibrillatory arrest was performed in 6 patients (3.9% of total CABG cases). The reasons of employing hypothermic ventricular fibrillation were as follows; calcified ascending aorta in 2 patients, coronary aneurysm associated with Behçet's decrease in 1, revascularization to the totally obstructed branches with poor left ventricular function in 2, and collateral circulation from bronchial artery with total obstruction of left main trunk in 1. The age range was 48 to 68 years with a mean of 59.0 +/- 7.8 years. Five patients had a history of myocardial infarction and 2 of them had a left ventricular ejection function less than 0.25. Surgical procedures consisted of elective ventricular fibrillation without aortic cross-clamp, systemic hypothermia and local pericardial cooling, left atrial or pulmonary artery venting, and local vessel isolation during distal anastomosis. Average number of grafts was 2.0 +/- 0.6, and 5 left internal thoracic arteries, 2 gastroepiploic arteries and 5 saphenous vein were used. Mean duration of ventricular fibrillation was 74.0 +/- 17.5 min. Postoperative angiography confirmed all bypasses patent. Only 1 patient, whose preoperative left ventricular ejection function was 0.20, died of heart failure 5 months after the operation. All other patients survived asymptomatically. Hypothermic fibrillatory arrest is useful and reliable technique in coronary artery bypass grafting when aortic occlusion or cardioplegic arrest is not desirable.
目前，心脏停搏几乎用于所有冠状动脉旁路移植术（CABG）。然而，在某些情况下，主动脉阻断或心脏停搏液输注并不适宜。在本文中，我们讨论了低温颤动停搏用于CABG的适应证及有效性。1992年4月至1995年3月，6例患者（占CABG病例总数的3.9%）接受了低温颤动停搏下的CABG。采用低温心室颤动的原因如下：2例升主动脉钙化；1例合并白塞病的冠状动脉瘤；2例左心室功能差的完全阻塞分支的血管重建；1例左主干完全阻塞且有来自支气管动脉的侧支循环。年龄范围为48至68岁，平均为59.0±7.8岁。5例患者有心肌梗死病史，其中2例左心室射血功能小于0.25。手术操作包括无主动脉阻断钳的选择性心室颤动、全身低温及局部心包降温、左心房或肺动脉排气以及远端吻合期间的局部血管分离。平均移植血管数为2.0±0.6，使用了5支左胸廓内动脉、2支胃网膜动脉和5条大隐静脉。心室颤动的平均持续时间为74.0±17.5分钟。术后血管造影证实所有旁路均通畅。仅1例术前左心室射血功能为0.20的患者术后5个月死于心力衰竭。所有其他患者均无症状存活。当主动脉阻断或心脏停搏不适宜时，低温颤动停搏在冠状动脉旁路移植术中是一种有用且可靠的技术。
