Fukushima J. Med. Sci.,Vol. 55, No. 2, 2009

[Original Article]

AORTIC ARCH REPAIR WITH CORONARY ARTERY
REVASCULARIZATION

HIROKI WAKAMATSU, YOICHI SATO, SHINYA TAKASE,
YOSHIYUKI SATO, HIRONO SATOKAWA
and HITOSHI YOKOYAMA

Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan

(Received March 26, 2009, accepted July 21, 2009)

Abstract: Objective: Simultaneous aortic arch repair and coronary artery bypass are associated with considerable morbidity and mortality. We retrospectively analyzed our experience with on- and off-pump coronary artery bypass (CAB) combined with aortic arch repair.
Methods: Before aortic arch repair, distal coronary artery anastomosis was constructed on the arrested heart under CAB (ONCAB: n=14), or on the beating heart before CAB (OPCAB: n=18). We also analyzed data from patients after isolated total arch replacement (TAR: n=20).
Results: Compared with ONCAB, OPCAB was associated with shorter periods of myocardial ischemia (133±24 vs. 180±48 min, P=0.017) and cardiopulmonary bypass (239±35 vs. 306±61 min, P=0.002), less prolonged postoperative ventilation (33% vs. 79%, P=0.027) and lower postoperative peak CK-MB levels (35±19 vs. 99±124 U/L, P=0.012). One (6%) patient after OPCAB and 3 (21%) after ONCAB (P=0.210) died in hospital. Compared with the TAR group, the myocardial ischemic periods after OPCAB (125±30 vs. 133±24 min, P=0.401) and postoperative outcomes were similar.
Conclusions: Aortic arch repair with OPCAB offers an option for treating aortic arch aneurysm accompanied by atherosclerotic coronary artery disease.

Key words: thoracic aortic aneurysm, heart disease, off-pump coronary artery bypass, cardiopulmonary bypass, operative surgical procedures

若松大樹，佐藤洋一，高瀬信弥，佐藤善之，横山　斉

Corresponding author: Dr. Wakamatsu
E-mail: hitoshiy@fmu.ac.jp
http://fmu.ac.jp/home/lib/F-igaku/
http://www.sasappa.co.jp/online/