自動吻合器を使用した大伏在静脈グラフト中枢側吻合の遠隔期開存率―手縫い吻合との比較・検討

Long Term Patency of Saphenous Vein Graft Using the Automated Proximal Anastomosis System Compared with the Hand-sewn Anastomosis System

冠状動脈バイパス術（CABG）において，近年人工心肺を使用しない術式（心拍動下CABG：OPCAB）が普及しつつある．その際，大動脈（Ao）-大伏在静脈（SVG）吻合には部分遮断鉗子を用いた直接吻合のほかに，特殊デバイスを用いた直接吻合，さらには自動吻合器を用いた機械的吻合などが行われている．当施設ではOPCABにおいて，2006年より特殊デバイスEncloseⅡ（Novare Surgical Systems社，Gilroy）を用いた直接吻合を，2007年より自動吻合器PAS-Port（Cardica社，Redwood City）の使用を開始した．しかし自動吻合器の遠隔成績はいまだ不明である．そこでわれわれは，PAS-Portの遠隔期開存率を調査してほかの方法と比較し，その有用性について検討した．

Backgrounds：The purpose of this study was to compare the long term patency of PAS-Port system with other hand-sewn anastomosis system.

Methods：From 2009 to 2018, a total of 79 anastomoses were done in coronary bypass surgery with PAS-Port system, and a total of 252 anastomoses with EncloseⅡ. Among them, 76 anastomoses with PAS-Port system （group P） and 246 anastomoses of encloseⅡ （group E） were evaluated using angiography or multislice computer tomography. We compared age, gender, emergency rate, hospital death and cerebral infarction between the 2 groups and evaluated the patency of the grafts from post-operative day 5 to year 10 to obtain their long term graft patency.

Results：Group P was significantly older, more male, and higher emergency rate. One patient in group P died of septic multiorgan failure and 1 died in group E of intestinal tract necrosis. Early patency rates of the graft were 97.4％ in Group P and 93.9％ in Group E. Long term patency rates were also comparable, but PAS-Port system showed tendency toward a higher rate of patency （log rank p＝0.057）.

Conclusions：The long term patency rate of PAS-Port automated proximal anastomosis is comparable with that of hand-sewn anastomosis.