非体外循环下冠状动脉旁路移植术治疗左冠状动脉主干合并3支血管病变

Off-pump Coronary Artery Bypass Grafting for the Treatment of Left Main with Three-vessel Coronary Disease

目的总结非体外循环冠状动脉旁路移植术(OPCAB)对左冠状动脉主干合并3支血管病变患者的治疗经验及体会。方法对33例左冠状动脉主干合并3支血管病变患者施行了OPCAB,用左乳内动脉作为移植血管与左前降支进行吻合,大隐静脉作为移植血管分别与回旋支、右冠状动脉/后降支、对角支和钝缘支进行吻合。结果每例患者行旁路血管移植2～5支,平均3.4支。无手术死亡,无围手术期心肌梗死、呼吸衰竭、肝肾功能衰竭等严重并发症,术后心绞痛均消失。结论OPCAB治疗左冠状动脉主干合并3支血管病变的高危冠心病患者是可行、有效的,手术损伤小;而积极的术前准备、主动脉内球囊反搏的应用、正确的手术方法和配合、建立一支熟练快速的应急队伍是确保手术成功的关键。

Objective To summarize experience in surgery about off-pump coronary artery bypass grafting(OPCAB)for the treatment of left main with three-vessel coronary disease. Methods OPCAB were perfomed in 33 patients of left main with three-vessel coronary disease. The left internal mammary artery(LIMA) was used to be the graft vessel to anastomose with left anterior descending. The saphenous vein was used to be the graft vessel to anastomose with left circumflex coronary artery, right coronary artery/posterior descend artery, diagonal branch, obtuse marginal branch. Results There was no operative death.The average number of grafting was 3.4 per case.There was no perioperative myocardial infarction, respiratory or hepatic or renal failure and other serious complications.Blood transfusion was not needed in 33% of cases.The angina pectoris was free after operation in all cases. Conclusions OPCAB is safe and effective for the treatment of left main with three-vessel coronary disease. The injuries were minimal. Preoperative preparation, using of intra-aortic balloon counterpulsation, operative matching, techniques and to create a skill and swift team for meet an emergency are the key factors to assure surgical outcome.