Serial Angiographic Evaluation Over 5 Years after Coronary Bypass Surgery

1994～1999年の間に単独冠動脈バイパス術を施行され術後の冠動脈造影を完了している症例中,再造影の承諾が得られた60症例に対して冠動脈造影を施行した.術後の平均観察期間は84ヵ月,バイパス総数134本,吻合総数162ヵ所であった.84ヵ月時の左内胸動脈グラフト:静脈グラフトの開存率は0.85:0.82で両群に有意差はなかった.また,吻合部位別にみた場合の開存成績は,前下行枝:回旋枝:右冠動脈それぞれ0.84:0.78:0.76であり,前下行枝へのバイパス開存成績が優れているものの3者間に有意差はなかった.標的冠動脈の狭窄度が75%以下:90%以上で分類した場合のグラフト開存成績は0.69:0.86と有意差(p=0.0003)を認めるが,この差は急性期の開存成績の差に起因するものであった.60症例中10例に心症状の再発を認め,うち6例はグラフト不全に起因するものであったが,残り4例は右冠動脈の新規病変に起因するものである.また,12例(20%)は無症状ながら今回造影時に新規の冠動脈病変を指摘され,PCIを施行されている.

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