Midterm Results of Radial Artery Graft in Coronary Artery Bypass Surgery: AC Bypass Technique versus Y-Graft Technique

1996年8月 から2002年12月 までに行った単独冠動脈バイパス術のうち, 左内胸動脈を左前下行枝に吻合 し, 橈骨動脈を回旋枝に吻合した162例 を対象 とした. 橈骨動脈を上行大動脈に中枢吻合 した135例 をAC 群, 橈骨動脈を左内胸動脈に端側吻合してY-graft とした27例 をY群 とし, 早期および中期成績の比較検 討を行った. 入院死亡は認めず, 術後合併症は脳梗塞を含めて両群間に差を認めなかった. 回旋枝への橈骨 動脈グラフ トの早期開存率は, AC群97.8%, Y群87.1%で 有意にY群 が不良であり(p=0.017), 術後 平均21.7±15.8カ 月の遠隔期開存率はAC群90.9%, Y群36.4%で, 有意にY群 が不良であった (p= 0.0008). AC群 において早期に良好に開存していた橈骨動脈グラフ トのうち遠隔期に問題を認めた症例はな かったが, Y群 において早期に良好に開存していた橈骨動脈グラフ トの25吻 合のうち3吻 合において, 遠 隔期に string sign となっていた. 橈骨動脈による回旋枝へのバイパスは, 左内胸動脈に端側吻合 してYgraft とするより, 可能なかぎり上行大動脈に中枢吻合すべきであると思われた. 日心外会誌34巻2号: 98-102 (2005)

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