J.Jpn. Surg. Soc.. 86(9): 1203-1207, 1985

---

Report on the annual meeting

CURRENT PROBLEMS IN CORONARY ARTERY SURGERY : NEW METHODS FOR MYOCARDIAL REVASCULARIZATION AND VASCULAR ANASTOMOSIS

Recently, aorto-coronary 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 : 60－90W, irradiatin time : 0.15－0.25sec) 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 coagulatin 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. Output of 20－40mW, and irradiatin time of 60－120sec were optimal conditions to make vascular anastomosis. Lower energy CO₂ Laser was clinically empolyed in 4 cases who were uneventful post-operatively.
In conclusion, it could be considered that these new methods for myocardial revascularization (arterialization of the coronary vein and Laser surgery) aorto-coronary bypass by CO₂ Laser might be clinically utilized in the near future.

---

---

To read the PDF file you will need Adobe Reader installed on your computer.