左胸前外侧小切口不停跳冠状动脉旁路移植术26例

Minimally invasive direct coronary artery bypass grafting via left anterior small thoracotomy: Report of 26 cases

目的探讨左胸前外侧小切口不停跳冠状动脉旁路移植术的效果.方法26例单支或2支血管病变经左胸前外侧小切口进胸,其中14例直视下游离乳内动脉,12例在胸腔镜辅助下游离,肝素化后切开心包,显露病变的靶血管,心脏跳动下行冠状动脉旁路移植术.结果26例手术顺利完成,22例旁路移植1支,4例旁路移植2支(1例行序贯吻合,3例桡动脉与乳内动脉行'Y'形吻合).术后无死亡及严重并发症.26例随访3个月～3年,平均16.8月,无心绞痛复发,心功能Ⅰ级18例,Ⅱ级8例.结论左前外侧小切口不停跳冠状动脉旁路移植术主要适用于前降支单支病变者,对于合并高危因素,不宜行常规冠状动脉旁路移植的多支血管病变病人亦适用.

Objective To explore results of minimally invasive direct coronary artery bypass grafting （MIDCAB） via left anterior small thoracotomy. Methods MIDCAB via left anterior small thoracotomy approach was performed in 26 cases of coronary artery disease with single or double vessels involvement. The left internal mammary artery （LIMA） was harvested under direct vision in 14 cases and under the assistance of thoracoscopy in 12 cases. After heparinization the pericardium was directly opened to expose the target vessels. The coronary artery bypass grafting was completed under beating heart. Results The procedure were smoothly completed in all the 26 cases. The left internal mammary artery was anastomosed to the left anterior descending artery （LAD） or the diagonal artery in 22 cases, while two bypass grafts were performed in 4 cases （ including 1 case of sequential grafting and 3 cases of internal mammary artery - radial artery Y - shaped grafting）. There were no serious postoperative complications and operative deaths found. All the 26 cases were followed for 3 months - 3 years （ mean, 16. 8 months） and no recurrence or death occurred. Conclusions MIDCAB via left anterior small thoracotomy is mainly suitable for patients with single LAD disease. However, it is also safe and effective in high - risk patients with multi - vessel disease who are not advisable for conventional procedures.