Coronary Artery Bypass Grafting Using in Situ Bilateral Internal Thoracic Arteries / 日本心臓血管外科学会雑誌

Coronary artery bypass grafting (CABG) using <i>in situ</i> skeletonized arterial conduits with an off-pump technique is a high quality and minimally invasive procedure. The internal thoracic artery (ITA) is the most reliable conduit as grafting the left anterior descending artery and circumflex arteries with bilateral ITAs leads to better long-term patient outcomes. In this study, we demonstrated the feasibility and usefulness of off-pump coronary artery bypass grafting surgery using bilateral ITAs. A total of 217 consecutive CABG cases using skeletonized ITA grafts were studied and they were divided into 2 groups are using unilateral ITA (UITA, <i>n</i>=104) and the other using bilateral ITA (BITA, <i>n</i>=113). OPCAB was completed in 94% (98/104) in the UITA group and in 99% (112/113) in the BITA group. The mean number of distal anastomoses per patient was 3.02 in the UITA group and 3.63 in the BITA group. The ITAs were used <i>in situ</i> in 100% (104 ITAs) in the UITA group and in 96% (217 ITAs) in the BITA group. One patient in the UITA group suffered from mediastinitis and one patient in the BITA group died due to intestinal ischemia 3 days after operation. Postoperative angiography was performed before discharge in 101 patients in UITA and 99 in BITA. The patency rate was 98.7% in the UITA group and 99.4% in the BITA group. OPCAB with bilateral skeltonized ITAs is a feasible and safe technique with excellent early clinical results and graft patency. OPCAB using <i>in situ</i> skeletonized artery conduits can become a standard surgical treatment for ischemic heart disease.

Midterm Results of Mitral Valve Repair with a Rigid Ring / 日本心臓血管外科学会雑誌

The purpose of this study was to analyze our results of mitral valve repair with a rigid annuloplasty ring (Carpentier-Edwards ring; Baxer-Edwards CVS Laboratories; Lrvine, Calif) in terms of its efficacy and safety. We have examined postoperative mitral regurgitation (MR) and left ventricular diastolic dimension (LVDd) in 63 cases of mitral valvoplasty during a period of 5 years. The operative methods were 20 cases of tendon reconstruction, 42 cases of quadrangular resection, and 15 cases of annuloplasty alone. Operative mortality and freedom from complications were examined at the mean 41.2 months after the operation. There were no operative deaths, and no case with severe MR postoperatively. From echocardiographic findings, the grade of MR changed from 3.13 to 0.28 postoperatively, and LVDd changed from 58.4±6.71 to 48.7±6.3ml postoperatively. Reoperation was performed in 2 cases (3.2%) several years after the first operation. The rate of midterm mortality was 4.8%. The postoperative mitral valve area was 2.85cm² in size of 26mm ring, 2.95cm² in size of 28mm, 3.09cm² in size of 30mm, which were measured from PHT (pressure half time) of the Doppler echocardiography. In conclusion, mitral valve repair with rigid annuloplasty ring (CE ring) provided good results for MR at midterm follow-up.

Mitral Valve Repair for Infectious Endocarditis / 日本心臓血管外科学会雑誌

Between January 1999 and August 2002, 13 patients with mitral regurgitation resulting from native valve endocarditis underwent surgery. The age of these patients was 54±13.8 years (range, 27 to 74 years); 8 patients were men. Five patients were categorized as New York Heart Association functional class III or IV. Endocarditis was active in 3 patients. Emergency or urgent surgery was required in 4 patients. Twelve patients underwent repair, and one had a valve replacement. Following the removal of all infected or nonviable tissue, a decision was made as to the possibility of repair. Repair was attemped in 13 patients and was successful in 12 patients. Most patients received ring annuloplasty with a Carpentier-Edward ring. Six patients had chordae ruptures, 5 patients had vegetations, and 2 patients had elongated chordae. Twelve patients were categorized as New York Heart Association functional class I, and one was categorized as class II at discharge. There were no hospital deaths. The mean follow-up of the 13 survivors was 24±14 months (range from 3 to 43 months). There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidities. We conclude that mitral valve repair is an effective treatment for inective endocarditis with mitral regurgitation.

Clinical Result of Consecutive 65 Cases of Minimally Invasive Direct Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

Minimally invasive direct coronary artery bypass grafting (MIDCAB) has been performed in some institutions and mid-term results have been reported. However, because of its technical difficulty, the procedure has not been gaining acceptance among cardiovascular surgeons. We report the clinical results of our MIDCAB series and describe the effect and role of the MIDCAB in the therapy of ischemic heart disease. From May 1999 through May 2002, 65 patients (age 29 to 90 years) underwent MIDCAB via a small left thoracotomy. Postoperative angiography was performed before discharge in all patients. No conversions to sternotomy were necessary. There were no operative, hospital or mid-term mortalities, nor were these any major complications, including myocardial infarction, stroke, respiratory failure, and other organ failure. Wound infection occurred in 1 patient. No graft occlusion was seen. Graft stenosis was seen in only 1 patient. The graft patency rate was 98.5% (66/67). Postoperative cardiac events included 2 incidents of angina, and 4 of atrial fibrillation. There were no incidents of congestive heart failure. MIDCAB is a safe and less-invasive operation. According to our clinical results, MIDCAB is an alternative to conventional coronary artery bypass grafting for selected patients, especially for those at high risk.

Recent Surgical Results of Transverse Aortic Arch Replacement / 日本心臓血管外科学会雑誌

We report the results of aortic arch replacement in 32 patients (20 males, 12 females) with aortic arch aneurysm, including 9 emergency cases. The etiology of aneurysm was atherosclerotic aneurysm in 18 patients, pseudoaneurysm in 1 patient, and aortic dissection in 13 patients. Selective cerebral perfusion (SCP) and retrograde cerebral perfusion (RCP), which are used for brain protection during aortic arch reconstruction, were both employed in this study according to our institutional policy. RCP was started at the moment of circulatory arrest after which the aneurysm was opened. In the case of 1-branch reconstruction or hemiarch replacement, we only employed RCP. If 2-branch reconstruction or total arch replacement was needed, we switched to SCP. After the distal graft anastomosis was performed, antegrade systemic perfusion was started via the 4th branch of the graft. Subsequently, 3 arch vessels was reconstructed with rewarming to shorten the SCP time, and finally proximal graft anastomosis was performed. Distal graft anastomosis with a new technique was applied in the 10 most recent cases. The “cuff” was made at the distal anastomosis site of the graft beforehand and this “cuff” was sutured to the aortic wall in an elephant-trunk fashion. This technique was a simple approach to repairing the distal lesion and allowed easy addition of stitches in case's of bleeding. The in-hospital mortality rate was 6.3% (2 of 32 patients) and the rate of cerebrovascular accident was 6.3% (2 of 32 patients). This technique for aortic arch repair is a useful method that results in low rates of in-hospital mortality and morbidity.