手技

もし、あなたやあなたの大切な人が冠動脈バイパス術(CABG)を医師から勧められた場合、ここに記載されている情報をご覧いただき、参考にしてください。

手術は、以下の2つが行われます。

血管採取: バイパス術の前に、バイパスグラフトとして使用する血管の採取を行います。この血管採取には、次の3つの方法があります。
従来の長切開による採取法、ブリッジング法、内視鏡下血管採取術(EVH)

冠動脈バイパス手術. 心臓への正常な血流を回復するために、閉塞した冠動脈周辺をバイパス用の血管を使用してバイパス(迂回)します。これらのバイパス用の血管は、患者自身の胸、脚、前腕から採取された動脈や静脈です。

The bypass part of the surgery

When using a vessel from the arm or leg a surgeon connects, or grafts, one end of the harvested vessel to the aorta- which allows blood to flow into the graft. The other end is attached to the coronary artery that has a blockage, bypassing the blocked portion of coronary artery to restore blood flow to the heart muscle.
It is not uncommon for a surgeon to perform one or more of these grafts during an operation — Depending upon how many bypass grafts the surgeon performs, this can be referred to as double (2), triple (3), quadruple (4) or more bypasses.

     Heart with bypass

 

During the bypass procedure, your surgeon has two options:

  1. Stop the heart and use a heart-lung machine (On-pump)
  2. Keep your heart beating during the operation (Off-pump)

On-pump Bypass

Bypass procedures became routine in the 1960s, following the invention of the heart-lung machine. The heart-lung machine is a device that temporarily does the job of the heart and lungs. This allow the heart to be stopped during CABG surgery. The heart-lung machine supplies oxygen to the blood and keeps blood circulating while a surgeon is sewing the grafts.

Once the operation is complete, the heart is returned to its normal rhythm and the heart-lung machine is no longer needed.

The heart-lung machine made it possible for surgeons to save the lives of millions of patients. However, there are potential risks involved in its use, especially for high-risk patients and those with diabetes or kidney disease. These patients are more likely to experience complications due to coronary surgery. 1,2,3

Off-pump Bypass

With off-pump bypass the heart continues to beat and supply oxygenatd blood throughout the body while the surgeon performs the bypass grafts. For some patients, the use of the heart-lung machine can add increased risk to their operation, or their surgeon may prefer to keep the heart beating during the operation to minimize the risk of certain complications.

1. Kowalewski M, Pawliszak W, Malvindi PG, Bokszanski MP, Perlinski D, Raffa GM, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis. J Thorac Cardiovasc Surg. 2016 Jan;151(1):60-77.
2. Wang Y, Shi X, Du R, Chen Y, Zhang Q. Off-pump versus on-pump coronary artery bypass grafting in patients with diabetes: a meta-analysis. Acta Diabetol. 2017 Mar;54(3):283-292.
3. Keeling WB, Williams ML, Slaughter MS, Zhao Y, Puskas JD. Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the society of thoracic surgeons national database. Ann Thorac Surg. 2013 Jul;96(1):83-8: discussion 88-9.

If your doctor has recommended CABG surgery for you or a loved one, this section will help you understand the surgical procedure commonly performed

The procedure consists of 2 steps:

Vessel Harversting. Obtaining a blood vessel to become the graft actually requires a separate procedure that is performed immediately before the bypass surgery is performed. This harvesting of a vessel is routinely done in one of three ways: traditional harvesting , bridging and minimally invasive endoscopic vessel harvest (EVH)

Heart Bypass Surgery. A surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel to resotre normal blood floww to the heart. These grafts usually come from the patient’s own arteries and vein located in the chest, leg or arm.