Since the drug eluting stents have appeared in Japan, the indication of percutaneous coronary intervention has wide-spread for the treatment of coronary artery disease. In this decade, 216 patients underwent emergency/urgent coronary artery bypass grafting (CABG) in our institute, while the annual numbers of both emergency and elective CABG cases have declined. On the contrary to the decreasing number, emergency CABG patients were significantly getting older with multiple co-morbidities. Thus, off-pump CABG was likely to be beneficial for preventing postoperative complications, leading to the reduction of postoperative mortality. When emergency CABG patients developed refractory myocardial ischemia and unstable hemodynamics, a percutaneous cardiopulmonary support system was quickly applicable and useful for on-pump beating CABG achieving complete surgical revascularization. In the present study, 1.8% of hospital mortality and 72.5% of a 10-years actuarial survival were documented. Although a trend of ACS patients were getting older and had multiple comorbidities in this decade, early and long-term outcomes following emergency CABG were considered to be acceptable.

View full abstract

Objective: The objective of this study was to estimate the impact of the ambulance with physician (the Doctor Car) on the performance of primary percutaneous coronary intervention (PCI) carried out for ST-elevation myocardial infarction (STEMI). Methods: We retrospectively assessed consecutive 116 patients, who were transferred to our hospital with STEMI and underwent primary PCI from January 2006 to October 2011. Patients were divided into 2 groups: the Doctor Car group (Group D, n=36) and the ordinary transferred group (Group N, n=80). The time taken for transportation and for reperfusion, the procedural aspects of the PCI, and the rate of in-hospital cardiac events were evaluated, and the 2 groups were compared. Results: Although the transportation time was longer in Group D (44±14 min) than Group N (29±11 min) (P<0.01), the arrival-to-reperfusion time (time elapsed from arrival of patient at the hospital to establishment of coronary artery reperfusion) was shorter (76±32 min vs 100±46 min, respectively; P=0.01), and the assisted circulation devices were less frequently used in Group D than in Group N (19% vs 46%, respectively; P=0.01). There was no significant difference between the groups in the rate of in-hospital cardiac events. Conclusions: Although the Doctor Car prolonged the transportation time, it reduced the arrival-to-reperfusion time and the use of the assisted circulation device.

View full abstract

From October 2000 to March 2011, 1391 consecutive patients underwent isolated OPCAB. Of these patients, 129 were on HD, and 111 patients underwent in situ ITA revascularization of LAD. An ipsilateral ITA graft to vascular access was used in 85 patients (IL group), while a contralateral ITA graft was used in 26 (CL group). The outcomes were retrospectively compared between the groups. The mean diameter of ITA as measured by preoperative TTE (rt 2.2 mm, lt 2.2 mm vs rt 2.3 mm, lt 2.2 mm, P=0.90, 0.88) and the intraoperative ITA graft flow according to an ultrasonic flow-meter (35.7 ml/min vs 43.2 ml/min, P=0.147) and the peak diastolic/systolic velocity according to early postoperative TTE (29.5/42.3 vs 30.1/42.4, P=0.843/0.983) were both similar between the IL and CL groups. No significant difference was observed regarding in-hospital mortality (5.9% vs 3.8%, P=0.69). The 1-, 3-, and 5-year survival ratio was 85%, 75%, and 56% in the IL group and 85%, 54%, and 34% in the CL group, respectively . Using of an ipsilateral ITA graft did not reduce the graft flow velocity during the intraoperative or early postoperative periods. No significant difference was observed between the two groups regarding mortality. From these results, both ITAs in HD patients are available for revascularization of LAD.

View full abstract

Aneurysmal dilatation of a saphenous vein graft (SVG) following coronary artery bypass grafting (CABG) is an extremely rare complication. We experienced a case with the aneurysm of SVG long after the CABG, where the resection and reconstruction of the bypass were performed using the left radial artery graft with an uneventful course after the reoperation. Herein, we report our case showing the preoperative angiography with the intraoperative findings, and review for the diagnosis and management of SVG aneurysm.

View full abstract

A 43-year-old man with heart failure and low ejection fraction underwent percutaneous coronary intervention (PCI) for LAD (#6), a chronic total occlusion lesion, and deployed a sirolimus eluting stent. A year and a half year later, follow-up CAG revealed a coronary aneurysm (7 mm) at the stenting position. Dual antiplatelet agents and anticoagulative agents were continued. Three years later, recent myocardial infarction occurred with vomiting and general malaise. Emergency CAG revealed stent thrombosis, and PCI to LAD by balloon dilation and BMS deployment after aspiration of thrombus was performed successfully. IVUS revealed coronary aneurysms and stent fracture. This report documented a rare case of very late stent thrombosis with coronary aneurysm and stent fracture after implanting a sirolimus eluting stent.

View full abstract

An 84-year-old man presented to our hospital with congestive heart failure. Coronary angiography was performed that indicated single coronary artery and the complicated triple vessel disease. The angiography showed that the coronary artery originated from a single ostium in the right sinus of Valsalva, and divided into 3 branches: the right coronary artery, left anterior descending (LAD) artery, and left circumflex artery (LCA). The coronary artery did not branch out into the left main. The LAD was anterior to the great vessels, whereas the LCA passed alongside the great vessels. We performed an on-pump beating-heart coronary artery bypass grafting, and his postoperative course was uneventful.

View full abstract

Giant coronary artery aneurysm is a rare coronary abnormality defined as coronary artery aneurysm diameter morethan 20 mm. Here, we describe the management and discuss the operative strategy we selected in the three cases ofgiant coronary aneurysm diagnosed by multidetected computer tomography (MDCT). The first case was a 53-year-oldhemodialysis patient presented with acute myocardial infarction. He underwent emergent percutaneous coronaryintervention on right coronary artery. Several days after the procedure, MDCT disclosed coronary artery aneurysm (26mm in diameter). Surgical resection of the aneurysm and coronary artery bypass grafting without use ofcardiopulmonary bypass were carried out. The second case was a 71-year-old woman. She was pointed out to have acardiac murmur and MDCT revealed a giant coronary artery aneurysm (more than 30 mm in diameter) with coronaryartery fistula located to the right of left anterior descending artery. Her coronary artery fistula and coronary arteryaneurysm were successfully treated by surgery performed under cardiopulmonary bypass. Postoperative course of thefirst and the second cases were uneventful and they were free of symptoms. The third case was a 60-year-old man whohad circumflex artery aneurysm (70 mm in diameter) with fistulous communication to the coronary sinus. Surgicaltreatment involves isolation and resection of coronary artery aneurysm with concomitant myocardialrevascularization. He had a complicated postoperative course, including ventricular tachycardia. The patientsubsequently had a gradual recovery and was discharged home.

View full abstract