| Quadruple, Quintuple and Sextuple
Bypass with Exclusive Use of In Situ Arterial Conduits in Coronary
Artery Bypass Grafting |
(Department of Cardiovascular Surgery, The Heart
Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan)
| Toru Ishida |
Hiroshi Nishida |
Yasuko Tomizawa |
| Sakashi Noji |
Hideyuki Tomioka |
Atsushi Morishita |
| Masahiro Endo |
Hitoshi Koyanagi |
|
|
Although sequential bypass with
in situ arterial conduits (the left and right internal thoracic
arteries; LITA and RITA, the right gastroepiploic artery; GEA)
in coronary artery bypass grafting (CABG) is technically demanding,
it is one of the most important procedures using a limited number
of in situ arterial conduits to revascularize a wide area. In
this report, we retrospectively investigated the clinical outcome
of CABG with 4 or more distal anastomoses using only in situ
arterial conduits. From December 1990 to May 1999,62 patients
underwent CABG with in situ arterial conduits, with at least
one sequential bypass. There were 59 men and 3 women patients
with mean age of 59.6 years (41 to 82 years). Mean postoperative
follow-up period was 32 months (1 to 101 months). The total number
of distal anastomoses was 4 (1 sequential bypass) in 54 patients,
4 (2 sequential bypasses) in 6 patients, 5 (1 sequential bypass)
in 1 patient and 6 (3 sequential bypasses) in 1 patient. There
were 5 emergency operations (8%), 37 patients (60%) had a history
of myocardial infarction, 30 patients (48%) had diabetes mellitus
and 6 patients (10%) had chronic renal failure and were on hemodialysis.
Left ventricular ejection fraction was 40% or less in 15 patients
(24%). There were no early deaths. Angiographic patency was satisfactory
for each graft (sequential: individual, LITA 96.7%: 100%, RITA
100%: 100%, GEA 89.5%: 97.4%). Patency of a distal anastomosis
of GEA was rather poorer than that of proximal (p＝0.03). Three
patients died during the follow-up period (all of them due to
malignancy). The 5-year actuarial survival and cardiac event-free
rate was 94.6% and 87.2%, respectively. In conclusion, although
an indication of GEA sequential grafting needs further study,
in situ arterial grafting with at least one sequential arterial
conduit was associated with excellent results and achieved more
complete revascularization with exclusive use of in situ arterial
conduits in patients with diffuse coronary artery disease.
Jpn. J. Cardiovasc. Surg. 30: 11-14（2001) |
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