Hayashi S, Sasaki M, Kawamoto J
Department of Cardiovascular Surgery, Chugoku Rosai Hospital, Kure, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jul;45(7):935-9.
The authors conducted urgent coronary artery bypass grafting (CABG) using only arterial graft for mild and moderate acute myocardial infarction (AMI) in 9 cases from January, 1995 through December, 1996. Mild and moderate AMI means free from cardiogenic shock by catecholamines alone or catecholamines and intra aortic balloon pumping (IABP). The period from the onset of AMI to admission was 2-24 (average 8 +/- 6) hours. Coronary arteriography (CAG) was performed immediately following admission. CABG was done immediately after CAG. CPK-MB on admission was 14-184 (average 67 +/- 61) IU/l. Three cases were main trunk disease over 90% stenosis, three cases were main trunk disease equivalent if another stenotic lesion over 99% were occluded, three cases would fall into cardiogenic shock if another stenotic lesion over 99% were occluded. Postoperative IABP was necessary for three cases. No case required repetition of IABP. For minimal operation time and to attain high graft flow, saphenous vein (SV) graft are generally used for emergencies. CABG was conducted here using only arterial graft (Mean anastomosis number was 2.3). There were 8 RITA grafts, 9 LITA grafts, and 4 RGEA grafts. Post operative CAG showed all the grafts to be patent, but string sign was noted for two LITA grafts. Prognosis was favorable in all cases. We could conduct urgent CABG surgery safely for mild and moderate AMI using only arterial grafts.
1995年1月至1996年12月，作者对9例轻度和中度急性心肌梗死（AMI）患者仅使用动脉移植物进行了急诊冠状动脉旁路移植术（CABG）。轻度和中度AMI是指仅通过儿茶酚胺或儿茶酚胺与主动脉内球囊反搏（IABP）即可避免心源性休克。从AMI发作到入院的时间为2 - 24（平均8±6）小时。入院后立即进行冠状动脉造影（CAG）。CAG后立即进行CABG。入院时肌酸磷酸激酶同工酶（CPK - MB）为14 - 184（平均67±61）IU/L。3例为主要血管病变，狭窄超过90%；3例为主要血管病变等效情况，即如果另一处狭窄超过99%的病变闭塞则会发生心源性休克；3例若另一处狭窄超过99%的病变闭塞就会陷入心源性休克。3例术后需要IABP。无一例需要重复使用IABP。为了缩短手术时间并实现高移植血管血流量，紧急情况下通常使用大隐静脉（SV）移植物。本研究仅使用动脉移植物进行CABG（平均吻合口数量为2.3个）。有8根桡动脉（RITA）移植物、9根左内乳动脉（LITA）移植物和4根右胃网膜动脉（RGEA）移植物。术后CAG显示所有移植物均通畅，但两根LITA移植物出现了串珠样征。所有病例预后良好。我们可以仅使用动脉移植物对轻度和中度AMI安全地进行急诊CABG手术。
