左開胸アプローチでの再冠状動脈バイパス術

Redo Coronary Artery Bypass Grafting Performed via Left Thoracotomy

冠状動脈バイパス術（coronary artery bypass grafting：CABG）後のグラフト閉塞に対する再CABGは，癒着による手術時間の延長，癒着剝離による開存グラフトの損傷などのリスクを伴う問題がある．再CABGに伴う死亡率は初回CABGにおける死亡率の2～5倍と報告されている1）．近年，再CABGは減少している2）が，グラフト閉塞後の経皮的冠状動脈形成術（percutaneous coronary intervention：PCI）が不適な病変などで再CABGが必要となる症例は少なからず存在する．

Eight patients underwent coronary artery bypass grafting （CABG） by left thoracotomy approach to the left coronary artery territory after CABG. The left subclavian artery was selected as an inflow anastomosis site, and the greater saphenous vein was used as a graft. The average operative time was 187 minutes, and the hospital stay was 12.2 days. Off-pump CABG was complete in all patients. There were no cases of mortality during hospitalization, and grafts were patent in the confirmed cases. We believe that the left thoracotomy approach avoids problems such as injury of the patent graft due to redo sternotomy, and reduces the mortality and complication rate.