Partial clamp を用いたオフポンプ冠動脈バイパス術の妥当性
オフポンプ冠動脈バイパス術（OPCAB）の際に，partial clamp を用いて上行大動脈に中枢側吻合を作成するグラフトデザインに対しての安全性，妥当性を検討した．当院では，術前胸部CT と術中epiaortic echo で上行大動脈の性状が良好と判断した症例ではpartial clamp を用いてRA またはSVG の中枢側吻合を行っている．当院で1998 年以降に施行したpartial clamp 併用OPCAB（P 群）469 例とaorta no-touch OPCAB 188例（N 群）を対象とした．周術期脳梗塞発症はP 群1％，N 群0.5％と同程度であった．グラフト本数はP...
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| Published in | 日本冠疾患学会雑誌 Vol. 21; no. 1; pp. 1 - 5 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本冠疾患学会
2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1341-7703 2187-1949 |
| DOI | 10.7793/jcoron.20.14-00018 |
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| Abstract | オフポンプ冠動脈バイパス術（OPCAB）の際に，partial clamp を用いて上行大動脈に中枢側吻合を作成するグラフトデザインに対しての安全性，妥当性を検討した．当院では，術前胸部CT と術中epiaortic echo で上行大動脈の性状が良好と判断した症例ではpartial clamp を用いてRA またはSVG の中枢側吻合を行っている．当院で1998 年以降に施行したpartial clamp 併用OPCAB（P 群）469 例とaorta no-touch OPCAB 188例（N 群）を対象とした．周術期脳梗塞発症はP 群1％，N 群0.5％と同程度であった．グラフト本数はP 群で3.4 本とN 群2.8 本に比べて有意に多く，術後早期の各グラフト開存率は両群間で同等であった．しかし5 年，10 年開存率はLITA，RITA，GEA では両群間で差はなかったが，RA，SVG の開存率はP 群で優れていた．Composite 使用比率は，N 群48％とP 群12％に比べ多かった．上行大動脈を精査した上でのpartial clamp は脳梗塞の合併率を上昇させず，中枢側吻合数に制限がないためグラフト本数を多くできる．またcomposite でのRA，SVG の遠隔期成績はA-C bypass よりも劣っていた．遠隔期に不安のあるcompositeグラフト使用を避ける上でもpartial clamp は有用であると思われる． |
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| AbstractList | オフポンプ冠動脈バイパス術（OPCAB）の際に，partial clamp を用いて上行大動脈に中枢側吻合を作成するグラフトデザインに対しての安全性，妥当性を検討した．当院では，術前胸部CT と術中epiaortic echo で上行大動脈の性状が良好と判断した症例ではpartial clamp を用いてRA またはSVG の中枢側吻合を行っている．当院で1998 年以降に施行したpartial clamp 併用OPCAB（P 群）469 例とaorta no-touch OPCAB 188例（N 群）を対象とした．周術期脳梗塞発症はP 群1％，N 群0.5％と同程度であった．グラフト本数はP 群で3.4 本とN 群2.8 本に比べて有意に多く，術後早期の各グラフト開存率は両群間で同等であった．しかし5 年，10 年開存率はLITA，RITA，GEA では両群間で差はなかったが，RA，SVG の開存率はP 群で優れていた．Composite 使用比率は，N 群48％とP 群12％に比べ多かった．上行大動脈を精査した上でのpartial clamp は脳梗塞の合併率を上昇させず，中枢側吻合数に制限がないためグラフト本数を多くできる．またcomposite でのRA，SVG の遠隔期成績はA-C bypass よりも劣っていた．遠隔期に不安のあるcompositeグラフト使用を避ける上でもpartial clamp は有用であると思われる． |
| Author | 和田, 賢二 古市, 吉真 小宮, 達彦 藤本, 侑花 境, 次郎 平岡, 俊文 恒吉, 裕史 藤本, 将人 田林, 東 川島, 隆 山中, 憲 村岡, 玄哉 金子, 寛行 島本, 健 |
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| References | 18) Davierwala PM, Leontyev S, Misfeld M, et al: No-touch aorta off-pump coronary bypass operation: arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg 2013; 95: 846–852 14) Manabe S, Fukui T, Miyajima K, et al: Impact of proximal anastomosis procedures on stroke in off-pump coronary artery bypass grafting. J Card Surg 2009; 24: 644–649 4) Lev-Ran O, Loberman D, Matsa M, et al: Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. Ann Thorac Surg 2004; 77: 102–107 10) van Dijk D, Nierich AP, Jansen EW, et al: Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation 2001; 104: 1761–1766 16) Jung SH, Song H, Choo SJ, et al: Comparison of radial artery patency according to proximal anastomosis site: direct aorta to radial artery anastomosis is superior to radial artery composite grafting. J Thorac Cardiovasc Surg 2009; 138: 76–83 12) Yamaguchi A, Adachi H, Tanaka M, et al: Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. Ann Thorac Cardiovasc Surg 2009; 15: 98–104 13) Daniel WT 3rd, Kilgo P, Puskas JD, et al: Trends in aortic clamp use during coronary artery bypass surgery: effect of aortic clamping strategies on neurologic outcomes. J Thorac Cardiovasc Surg 2014; 147: 652–657 1) 日本冠動脈外科学会：2012 年全国アンケート結果http://www.jacas.org/enquete/2012.html 2) ElBardissi AW, Aranki SF, Sheng S, et al: Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg 2012; 143: 273–281 9) Katz ES, Tunick PA, Rusinek H, et al: Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992; 20: 70–77 7) Manabe S, Takanashi S: Strategy to prevent cerebral complication in coronary artery bypass grafting. J Jpn Coron Assoc 2011; 17: 160–164(in Japanese 8) Bucerius J, Gummert JF, Borger MA, et al: Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 2003; 75: 472–478 17) Lee SH, Chung CH, Jung SH, et al: Midterm results of beating heart coronary bypass surgery for non-left internal thoracic artery anastomosis according to grafting design and implications of intraoperative flow characteristics on graft patency. Thorac Cardiovasc Surg 2012; 60: 438–445 6) Shroyer AL, Coombs LP, Peterson ED, et al: The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 2003; 75: 1856–1864 3) Emmert MY, Seifert B, Wilhelm M, et al: Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2011; 142: 1499–1506 5) Wareing TH, Davila-Roman VG, Daily BB, et al: Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg 1993; 55: 1400–1407 11) Hirose H, Amano A, Takahashi A: Side clamp used during off-pump coronary artery bypass does not increase the risk of stroke. Med Sci Monit 2002; 8: 235–240 15) Shimokawa T, Minato N, Yamada N, et al: Assessment of ascending aorta using epiaortic ultrasonography during off-pump coronary artery bypass grafting. Ann Thorac Surg 2002; 74: 2097–2100 |
| References_xml | – reference: 4) Lev-Ran O, Loberman D, Matsa M, et al: Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. Ann Thorac Surg 2004; 77: 102–107 – reference: 15) Shimokawa T, Minato N, Yamada N, et al: Assessment of ascending aorta using epiaortic ultrasonography during off-pump coronary artery bypass grafting. Ann Thorac Surg 2002; 74: 2097–2100 – reference: 1) 日本冠動脈外科学会：2012 年全国アンケート結果http://www.jacas.org/enquete/2012.html – reference: 2) ElBardissi AW, Aranki SF, Sheng S, et al: Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg 2012; 143: 273–281 – reference: 9) Katz ES, Tunick PA, Rusinek H, et al: Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992; 20: 70–77 – reference: 14) Manabe S, Fukui T, Miyajima K, et al: Impact of proximal anastomosis procedures on stroke in off-pump coronary artery bypass grafting. J Card Surg 2009; 24: 644–649 – reference: 17) Lee SH, Chung CH, Jung SH, et al: Midterm results of beating heart coronary bypass surgery for non-left internal thoracic artery anastomosis according to grafting design and implications of intraoperative flow characteristics on graft patency. Thorac Cardiovasc Surg 2012; 60: 438–445 – reference: 10) van Dijk D, Nierich AP, Jansen EW, et al: Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation 2001; 104: 1761–1766 – reference: 6) Shroyer AL, Coombs LP, Peterson ED, et al: The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 2003; 75: 1856–1864 – reference: 13) Daniel WT 3rd, Kilgo P, Puskas JD, et al: Trends in aortic clamp use during coronary artery bypass surgery: effect of aortic clamping strategies on neurologic outcomes. J Thorac Cardiovasc Surg 2014; 147: 652–657 – reference: 12) Yamaguchi A, Adachi H, Tanaka M, et al: Efficacy of intraoperative epiaortic ultrasound scanning for preventing stroke after coronary artery bypass surgery. Ann Thorac Cardiovasc Surg 2009; 15: 98–104 – reference: 5) Wareing TH, Davila-Roman VG, Daily BB, et al: Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg 1993; 55: 1400–1407 – reference: 8) Bucerius J, Gummert JF, Borger MA, et al: Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 2003; 75: 472–478 – reference: 11) Hirose H, Amano A, Takahashi A: Side clamp used during off-pump coronary artery bypass does not increase the risk of stroke. Med Sci Monit 2002; 8: 235–240 – reference: 16) Jung SH, Song H, Choo SJ, et al: Comparison of radial artery patency according to proximal anastomosis site: direct aorta to radial artery anastomosis is superior to radial artery composite grafting. J Thorac Cardiovasc Surg 2009; 138: 76–83 – reference: 18) Davierwala PM, Leontyev S, Misfeld M, et al: No-touch aorta off-pump coronary bypass operation: arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg 2013; 95: 846–852 – reference: 3) Emmert MY, Seifert B, Wilhelm M, et al: Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2011; 142: 1499–1506 – reference: 7) Manabe S, Takanashi S: Strategy to prevent cerebral complication in coronary artery bypass grafting. J Jpn Coron Assoc 2011; 17: 160–164(in Japanese) |
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| Title | Partial clamp を用いたオフポンプ冠動脈バイパス術の妥当性 |
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