Does Terminal Warm Blood Cardioplegia Improve Myocardial Preservation during Coronary Arterial Bypass Grafting? / 日本心臓血管外科学会雑誌

We investigated the clinical results of coronary arterial bypass grafting (CABG), using a terminal warm blood cardioplegia (TWBCP) for myocardial preservation. In the past 6 years, 102 cases of CABG have been performed at our institution. These 102 cases were divided into the following two groups; (1) Group T, consisting of 41 cases, in which TWBCP was employed; (2) Group non-T, consisting of 61 cases, in which TWBCP was not employed. We performed a comparative study between the groups on the perioperative cardiac function and so on. Between the two groups, there were no significant differences in age, gender, preoperative ejection fraction (EF), operative time, cardiopulmonary bypass time (CPBT) and the level of CPK-MB. In group T, the number of grafts was significantly more than that in group non-T (<i>p</i>=0.002). Aortic cross-clamp time was significantly longer in group T. However, the duration of assisted circulation after aortic declamp was significantly longer in group non-T than that of group T (<i>p</i>=0.01). The incidence of ventricular fibrillation after release of aortic clamp in group T was 9.8%, while it was 67.2% in group non-T, showing a significant difference. Furthermore, the postoperative cardiac index in group T was significantly higher than that in group non-T. These results suggest that it is important for the myocardium, to recover from its ischemic damage caused by VF after release of aortic cross-clamp. In conclusion, we consider it effective to employ TWBCP in CABG to improve postoperative cardiac function.

Recurrent Suprarenal Abdominal Aortic Aneurysm(AAA) after Repair Infrarenal AAA / 日本心臓血管外科学会雑誌

We encountered a recurrent suprarenal abdominal aortic aneurysm (AAA) patient with coronary artery disease and hyperlipidemia after repair of infrareanal AAA. A 72-year-old woman complaining of an abdominal throbbing mass was admitted. Computed tomography (CT) and aortography revealed infrarenal AAA which was totally removed and Dacron graft was replaced. The patient was followed as an outpatient. At the time of initial graft replacement there was no remarkable aneurysmal change in suprarenal abdominal aorta. Five years after the initial operation, a suprarenal AAA 5cm in diameter was detected by ultra sonographic examination. CT scan and aortography confirmed suprarenal AAA involving the celiac trunk of the supramesenteric artery and renal artery. Redo AAA operation with reconstruction of these branches was performed under V-A bypass support in a thoracoabdominal approach. Slight renal and liver dysfunction occurred postoperatively. However, serum creatine GOT and GPT values normalized by the ninth postoperative day. Postoperative aortography revealed patency of all branches.