超高齢者に対する左小開胸下冠状動脈バイパス術の2例

Minimally Invasive Cardiac Surgery-Coronary Artery Bypass Grafting by Left Small Intercostal Thoracotomy for Very Elderly Patients：Report of Two Cases

はじめに　社会の高齢化に伴う手術患者の年齢上昇は近年より顕著となり，それに伴い80歳代や90歳代の患者への心臓大血管手術も増加してきている1，2）．手術侵襲に伴う日常生活動作（ADL）の低下は高齢者でより顕著であり，術後に介護の必要度が増すことや長期の入院を余儀なくされることは，社会にとって大きな負担ともなりうる．したがって，高齢者における手術侵襲の軽減はそのような問題の解決の一助になりうると期待される．われわれは超高齢者の虚血性心疾患に対し，左肋間小開胸下での低侵襲心臓手術・冠状動脈バイパス術（MICS-CABG）を施行し，良好な結果を得たので報告する．

The increase in the age of patients undergoing operations has become more prominent in recent years. We report our experience of minimally invasive cardiac surgery-coronary artery bypass grafting （MICS-CABG） by left small intercostal thoracotomy for very elderly patients.

Case 1：The patient was a 91-year-old woman with a history of percutaneous coronary intervention （PCI） for left anterior descending artery （LAD） and right coronary arteries at different timings. Due to her contrast media allergy, we performed MICS-CABG to treat 75％ stenosis of LAD. Blood transfusion was not required. She was discharged on the 13th day.

Case 2：The patient was a 92-year-old man. We performed MICS-CABG for 75％ stenosis of the left main trunk and 90～99％ stenosis of the LAD with severe calcification. Blood transfusion was not required. He was discharged on the 21th day.

MICS-CABG can be performed with less invasiveness in comparison to the conventional method and therefore seems to be an effective method of surgery for very elderly patients.