Less Invasive Aortic Valve Replacement Following Coronary Artery Bypass Grafting Using the Internal Thoracic Artery: Usefulness of Balloon Occlusion of the Internal Thoracic Artery Graft

内胸動脈(ITA)使用による冠動脈バイパス術(CABG)の既往を有する患者における大動脈弁置換術(AVR)においては,適切な心筋保護のために,開存したITAグラフトの剥離,遮断が必要となる.そのさい癒着剥離に時間を要し,グラフト損傷にも注意を要する.われわれはITA使用によるCABGの既往を有するAVR患者2例に対して術式の簡素化のために術前ITA閉塞用balloonを留置し,大動脈遮断の間ITAグラフトをballoonで閉塞し,良好な心筋保護効果を得た.また癒着剥離を上行大動脈周囲に限局できるため,手術時間の短縮,出血量の減少につながった.ITAグラフトballoon閉塞法は,冠動脈バイパス術の既往を有する大動脈弁置換術の低侵襲化に有効な方法と考えられた.

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