左内胸動脈開存例の不安定狭心症に対して左開胸下OPCABが奏効した1例

Redo Coronary Artery Bypass Grafting Through Left Thoracotomy in Patient with Patent Left Internal Thoracic Artery Graft；Report of a Case

再冠状動脈バイパス手術（CABG）においては，胸骨再切開時の心臓損傷や機能グラフト損傷，グラフト選択の制限などの問題があり，手術死亡率も初回手術に比べ高いことが報告されている1）．われわれは，左内胸動脈（LITA）が開存グラフトである再CABG例において左開胸下心拍動下CABG（OPCAB）で，良好な結果を得たので報告する．

A 61-year-old man was admitted because of unstable angina. The patient had a history of CABG ［LITA-left anterior descending artery （LAD）, aorta-saphenous vein graft （SVG）-posterolateral branch （PL）-diagonal branch （D1）］4 years ago. Coronary angiography revealed an occlusion of old SVG at proximal anastomosis site and a stenosis of native high lateral artery （HL）. To reduce the risk of cardiac injury and damage to the patent grafts due at sternal reentry, we performed redo CABG through left thoracotomy. The proximal site of SVG was anastomosed to descending aorta using automated proximal anastomosis system. The SVG was anastomosed to the HL and old SVG in a sequential mode. Postoperative course was uneventful and the patient was discharged on postoperative day 14. Redo CABG through left thoracotomy provides safe and effective surgical approach in patient who requires revascularization of left circumflex territory.