[Current problems in coronary artery surgery: new methods of myocardial revascularization and vascular anastomosis].
Recently, aortocoronary bypass for the patients with ischemic heart disease has been widely performed and excellent operative results have been obtained in Japan. But, there are some problems in coronary artery surgery for the patients with small coronary artery or multiple stenoses of the coronary arteries. For the purpose to resolve of these problems, operative transluminal angioplasty and onlay patch grafting have been routinely done for severely ill cases, and good patency rate of bypass grafts has been confirmed by postoperative angiography in our clinic. Another problem is alternative surgical treatment for these patients whom A-C bypass could not be done, because of diffuse stenosis of the coronary arteries. As a new method of myocardial revascularization for such cases, arterialization of the coronary venous system (Ao-CS bypass, or Ao-LADV bypass) was experimentally performed. Subsequently, improvements of hemodynamics and blood gas analysis during the bypass were obviously recognized in the latter group. Besides, transmyocardial punctures were created by CO2 Laser (output: 60-90 W, irradiation time: 0.15-0.25 sec) in the ischemic myocardium. Newly created myocardial channels were microscopically studied from the stand points of tissue reaction and patency rate. Subsequently, tinned layers of carbonization and coagulation necrosis were observed in the channels and they disappeared gradually, and long-term patency of the channels could be apparently expected from these findings. On the other hand, vascular anastomosis (side-to-side, end-to-end, and end-to-side) by low energy CO2 Laser was experimentally done in which good healing at the site of anastomosis could be microscopically observed.(ABSTRACT TRUNCATED AT 250 WORDS)
D000818:Animals; D001026:Coronary Artery Bypass; D004285:Dogs; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*