中枢側自動吻合器を使用した冠状動脈バイパス術後のStanford A型急性大動脈解離

Stanford Type A Acute Aortic Dissection after Coronary Artery Bypass Grafting using Automated Proximal Anastomotic Device

冠状動脈バイパス術（CABG）後にStanford A型急性大動脈解離を発症した症例報告は散見されるが，中枢側自動吻合器を用いたCABG例での報告はきわめてまれである．われわれは，Stanford B型大動脈解離の既往を有し，中枢側自動吻合器PAS-Port（Cardica社，Redwood City）を使用した心拍動下冠状動脈バイパス術（OPCAB）後にStanford A型急性大動脈解離を発症した1例を経験したので報告する．

Stanford type A acute aortic dissection after off-pump coronary artery bypass grafting （OPCAB） is a rare but potentially fatal complication. A 61-year-old man with subacute Stanford type B aortic dissection underwent a triple OPCAB using an automated proximal anastomotic device. On postoperative day 4, he had a sudden syncope. An enhanced computed tomography （CT） scan revealed Stanford type A acute aortic dissection. He underwent emergent total aortic arch replacement along with an open stent graft deployment. The entry of the dissection was located at the proximal anastomosis site of the vein graft. This case demonstrates that this device should be used carefully in patients with a history of Stanford type B aortic dissection.