It has been reported that the left internal thoracic artery (LITA) should be used for CABG when its free flow is more than 40-80ml/min. In the past 6 years, 120 cases of CABG have been performed in our institution. In 71 of these 120 cases, LITA was anastomosed to the left anterior descending coronary artery (LAD). These 71 cases can be divided into the following two groups: Group L consists of 14 cases, in which LITA-FF was less than 20ml/min. Group H consists of 57 cases, in which LITA-FF was 21ml/min or more. In all cases, LITA was dissected by electrocauterization. Papaverine administration and balloon dilation of LITA were not employed. We performed a comparison study between the groups based on post operative coronary angiographic findings. In group H, LITA graft occlusion was identified in 3 cases, and “string sign” in 7 cases. In group L, “string sign” was identified in only 1 case, and there was no LITA graft occlusion. There was no significant difference between the two groups. Satisfactory results of early graft patency were achieved as follows: 94.7% in group H, 100% in group L. These results suggest that LITA can be used for CABG, even when the free flow is less than 20ml/min.

We investigated the clinical results of coronary arterial bypass grafting (CABG), using a terminal warm blood cardioplegia (TWBCP) for myocardial preservation. In the past 6 years, 102 cases of CABG have been performed at our institution. These 102 cases were divided into the following two groups; (1) Group T, consisting of 41 cases, in which TWBCP was employed; (2) Group non-T, consisting of 61 cases, in which TWBCP was not employed. We performed a comparative study between the groups on the perioperative cardiac function and so on. Between the two groups, there were no significant differences in age, gender, preoperative ejection fraction (EF), operative time, cardiopulmonary bypass time (CPBT) and the level of CPK-MB. In group T, the number of grafts was significantly more than that in group non-T (p=0.002). Aortic cross-clamp time was significantly longer in group T. However, the duration of assisted circulation after aortic declamp was significantly longer in group non-T than that of group T (p=0.01). The incidence of ventricular fibrillation after release of aortic clamp in group T was 9.8%, while it was 67.2% in group non-T, showing a significant difference. Furthermore, the postoperative cardiac index in group T was significantly higher than that in group non-T. These results suggest that it is important for the myocardium, to recover from its ischemic damage caused by VF after release of aortic cross-clamp. In conclusion, we consider it effective to employ TWBCP in CABG to improve postoperative cardiac function.

An 85-year-old man was admitted complaining of chest pain. The ECG showed ST depression in leads II, III, _aV_F, V₃-V₆ and Q wave in leads I, _aV_L with elevation in ST segments. An emergency coronary angiography revealed 75% stenosis in the left main trunk, 75-90% stenosis in the left anterior descending artery, total occlusion in the acute marginal branch, 75% stenosis in the left circumflex artery, and 75% stenosis in the right coronary artery. He was treated medically, because he was old and his hemodynamics were stable. About 39h later, he lost consciousness suddenly and was shown to have cardiogenic shock. Echocardiogram revealed pericardial effusion. Percutaneous drainage was performed, resulting in improved blood pressure and level of consciousness. He was transferred to Okaya Enrei Hospital and received emergency surgery for subacute LVFWR. A sutureless repair and coronary bypass was performed under cardiopulmonary bypass and cardiac arrest. He experienced no major complication and was discharged 40 days after surgery. It is concluded that the sutureless technique allowed for a shorter operation time and concomitant coronary bypass successfully prevented pseudoaneurysm and improved cardiac function. A higher quality operation is possible by using a combination of on-pump, cardiac arrest, coronary bypass and left ventricle repair with the sutureless technique in such cases in which treatment is needed for cardiac arrest as in the above example. This method contributed to an improved prognosis.