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

The internal thoracic artery (ITA) has been established as the preferred conduit for myocardial revascularization. Several reported improved late results of coronary artery bypass grafting (CABG) with bilateral internal thoracic arteries (BITAs). In our institute, BITAs have been used for CABG from 1993. Since 1995, the indications for use of BITAs were extended to high risk patients. Between January 1995 and December 1997, 119 patients received BITAs for coronary artery revascularization. Right ITAs were anastomosed to the left anterior descending arteries (65%), the diagonal branches (7%), the left circumflex arteries (12%) and the right coronary arteries (10%). In 8 patients (7%), free right ITAs were used to bypass between proximal and distal portions of the right coronary artery. The hospital mortality rate was 4.2%. Regarding hospital morbidity, there were 2 patients with sternal infection and 2 patients with LOS postoperatively. There was no reoperation for bleeding. No significant difference was observed in the rate of wound infection or rate of operation without blood transfusion between the patients having BITAs grafting and those having unilateral ITA or saphenous vein grafting only, during the same period. Diabetes mellitus, older age, feminine gender, reduced ejection fraction and urgent operation are known risk factors for CABG. Among patients with these factors, no significant difference was observed in hospital mortality rate between patients with BITAs grafting and those with unilateral ITA grafting. The operative results of CABG using BITAs were considered to be satisfactory.

Large Ascending Aortic Aneurysms Eroding the Sternum / 日本心臓血管外科学会雑誌

In particular, pseudoaneurysms formed at suture lines often are injured during resternotomy. Between 1993 and 1997, 5 patients with large ascending aortic aneurysms eroding the sternum underwent graft replacement using profound hypothermic circulatory arrest. A VA bypass was established through the femoral artery and vein and the patients were cooled to achieve profound hypothermia. After total disappearance of EEG activity was confirmed, circulatory arrest was established and resternotomy was conducted. In 4 patients who had pseudoaneurysms at proximal suture lines, the aneurysms were injured during resternotomy, however the grafts above the aneurysms were clamped 5 to 10min after resternotomy and cardiopulmonary bypass resumed. Infected grafts were removed and replaced with new grafts in 4 cases and hemiarch repair was conducted in 1 case. There was 1 hospital death due to multiple organ failure. Four patients survived operations and were discharged without any deficit. The hypothermic circulatory arrest technique makes it easier to obtain a good operative field and to manage any rupture immediately than by the selective cerebral perfusion technique.