上行弓部大動脈置換術における解剖学的吻合法―3D吻合の紹介

Three-dimensional Anatomical Anastomosis in Total Arch Replacement

上行大動脈は下から上へ右側に凸の弧状を呈し，弓部大動脈は前から後ろへ上側に凸の弧状を呈している．この異なるカーブをストレートの人工血管で繋ぎ合わせるには無理がある．1本の人工血管で上行弓部大動脈置換術を行った場合，人工血管が途中で折れてしまうことをしばしば経験する．人工血管の屈曲は狭窄や溶血などの弊害を起こす可能性が報告されており1），望ましいことではない．

The ascending aorta and the aortic arch curve 3-dimensionally from the right front of the heart to its left rear. If this curve is replaced or connected with a straight artificial graft, the curve will lose its natural shape. Here, we reconstructed the ascending aorta and the aortic arch with 2 different types of grafts, and devised a 3-dimensional （3D） structure by anastomosis.

“3D anastomosis” first involves reconstructing the ascending aorta and the aortic arch with separate grafts. An oblique incision was then made at the proximal stump of the aortic arch graft so that its tip pointed to the right side of the patient. Similarly, an oblique incision was made at the distal stump of the ascending aorta graft so that its tip pointed to the anterior position of the patient. Then, the 2 grafts were anastomosed in a twisted manner of 90 degrees. Therefore, a 3D form was created from the right front of the heart to its left rear. We achieved good results in 14 patients using this method.