Long-term result of aorto-coronary bypass surgery

Four hundred and nineteen cases of aorto-coronary bypass surgery which were operated at the Juntendo University Hospital for last 8 years were reviewed with respect to operative, hospital and late mortality, and survival. Isolated coronary bypass (371 pts) had 2.7 per cent of operative mortality, 1.9 per cent of hospital mortality, 1.3 per cent of late mortality and 94.1 per cent of survival rate postoperative follow-up ranged up to 8 years (average 3.51 years). Late mortality was 2.6 per cent in the group of left main trunk lesion, 1.3 per cent in the group of patients over 60 years old, 0.7 per cent in single bypass group, 1.2 per cent in double bypass and 6.7 per cent in triple bypass group. Patients complaining of unstable angina showed significantly higher operative, hospital and late mortality compared with patients with stable angina. Cardioplegia for an intraoperative myocardial protection provided better operative result, however, there is no significant difference in late mortality between potassium-induced and potassium-magnesium-induced cardioplegia. Intraoperative myocardial protection using lidocaine, aprotinin and coenzyme Q10 is important to improve surgical results in patients with either left main trunk lesion or age over 60. Successful treatment of 5 patients with evolving or acute myocardial infarction was experienced. These results suggest that aorto-coronary bypass surgery is accepted as a safe and important treatment for ischemic heart disease.     

A study of the long-term graft patency using a saphenous vein graft following aorto-coronary bypass surgery

Long term graft patency after aorto-coronary (A-C) bypass surgery has been reported in the West and the data shows a lower patency rate in saphenous vein grafts (SVG) than internal mammary artery grafts. We studied the long term SVG patency in cases of Japanese patients at our institute, and we have compared our results with those in the West. The subjects, including children, were 211 cases who received A-C bypass surgery using at least one SVG from Jan., 1975 to Sept., 1989. 182 of these cases (examination rate: 86%) received a postoperative angiography one or three months after surgery. The postoperative study took the form of either a selective coronary angiography or a digital subtraction angiography. In 81 cases, using the same two methods, graft patency was reconfirmed from one to eleven years after surgery. Early graft patency including children was 95%. Long term graft patency in the adult cases was 89% from 1 to 2 years (mean: 1.3 years), 94% from 2 to 5 years (mean: 3.2 years), 88% from 6 to 11 years (mean: 7.1 years) following the operation. Six patients died during the post operative follow up period. Two cases were sudden death, one resulted from a reoperation for recurrent angina, two were caused by malignant neoplasm and other was the result of a cerebro-vascular accident. The results correlating the long term graft patency using a SVG and long term mortality were not as negative at our institute as they have been in studies done in the West.     

Minimally invasive coronary artery bypass grafting surgery in a child with Kawasaki disease

An 8-year-old girl with Kawasaki disease underwent surgical revascularization to the left anterior descending coronary artery on the beating heart via a left anterior short thoracotomy. Angiography 21 months after surgery showed excellent graft patency. This case--the first success in minimally invasive surgical coronary artery revascularization in a child in the world--suggests that minimally invasive methods are a reasonable alternative in coronary artery revascularization in a child with Kawasaki disease whose left anterior descending artery is the only requiring it.     

Myocardial protection by lidocaine hydrochloride in aorto-coronary bypass surgery

Myocardial protective effect of lidocaine hydrochloride on the ischemic myocardium was evaluated by serum (MB-CK) and cardiac function in 48 patients; 24 patients in control (C) and 24 patients in lidocainetreated group (L), who underwent aorto-coronary bypass surgery. Lidocaine hydrochloride, 1 mg/min was administered by continuous drip infusion from initiation of anesthesia, and throughout the operation and postoperative period for 24 hours. There were no significant differences between two groups with regard to duration of cardioplegia and cardiopulmonary bypass, hypothermic level and the number of grafts implanted. Serum MB-CK at 18–24 hours following cardioplegia was 39.5±15.2 I.U. (C) and 14.2±4.0 I.U. (L), (p<0.05). Cardiac index and stroke volume index were significantly increased in the lidocaine-treated group at 24 hours following aortocoronary bypass surgery, as compared to the control group. Lidocaine thus appears to be beneficial in aorto-coronary bypass surgery to prevent ischemic changes in the myocardium. The gist of this paper was read at the 82nd Meeting of the Japanese Surgical Society, April, 1981.     

Results of sequential aorto-coronary bypass grafting using saphenous vein graft

Seventy patients underwent sequential coronary artery bypass grafting with saphenous vein during 28 months period. Seventy eight sequential grafts comprising 165 distal anastomoses were performed. Early death was 2.9%. Postoperative angiographic evaluation within 6 months showed 86% patency of the 65 sequential grafts and 89% patency of the 136 distal anastomoses. The patency of anastomosis to left anterior descending artery (LAD), diagonal branch (Dx), obtuse marginal branch (OM), posterior lateral branch (PL), and posterior descending branch (PD) was 87% (13/15), 92% (36/39), 91% (40/44), 81% (26/32) and 100% (6/6), respectively. The patency of Dx-LAD, Dx-OM and OM-PL was 86% (12/14), 94% (15/16) and 76% (13/17), respectively. There was no significant difference in the patency rate according to the site of anastomosis and the inner diameter of the coronary artery. The patency of side to side anastomoses was 92% (65/71) which was not significantly different from that of the end to side anastomoses; 86% (56/65). These results showed sequential aorto-coronary vein grafting means to be effective for the complete coronary artery revascularization .     

Coronary artery bypass graft surgery in a patient with haemoglobin SC disease

Patients with sickle cell disease who undergo surgery are generally considered to be at greater risk of peri-operative complications than otherwise healthy patients. We report a case of a woman with haemoglobin SC disease undergoing coronary artery bypass grafting. She was successfully managed with pre-operative exchange transfusion and normothermic cardiopulmonary bypass.