非体外循环冠状动脉旁路顺行序贯移植术

Off-pump Coronary Artery Bypass Grafting Bridge Vessels Anterograde Sequential Technique

目的探讨先吻合桥血管近端的顺行序贯非体外循环心脏不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)应用的临床意义。方法62例患者行OPCABG,将桥血管与升主动脉吻合后备用,再行左乳内动脉与前降支吻合,最后进行桥血管与其他靶血管顺行序贯式吻合。结果吻合到左前降支的桥血管:带蒂左乳内动脉57支,桡动脉2支,大隐静脉3支。采用大隐静脉桥血管顺行序贯吻合其他靶血管,3支桥47例,2支桥15例。术后1例因低心排血量综合征死亡。其余61例术后心绞痛症状全部缓解,无围术期急性心肌梗死。经3～36月随访,无新发心绞痛,生活质量提高。结论非体外循环心脏不停跳冠状动脉旁路顺行序贯移植术,可以避免体外循环和心脏停搏心脏停搏的弊端;每完成一个桥血管吻合口,即恢复该部位心肌的血液供应,更早改善心肌缺血缺氧状态,手术安全、有效。

Objective To evaluate the clinic value of off-pump coronary artery bypass grafting （OPCABG） bridge vessels anterograde sequential graft.Methods Sixty two cases were performed on OPCABG using bridge vessels anterograde sequential technique. Bridge grafting was anastmosis with aorta using greater saphenous vein or radial artery. The in situ left internal mammary artery （LIMA） is the choice to left anterior descending branch （LAD）. Then, anterograde sequential grafting was performed with target artery.Results The bridge vessels anastomosed to LAD were as follows： 57 branches of pedicle LIMA, 2 of radial artery, and 3 of greater saphenous vein. The anterograde sequential grafts with greater saphenous vein included： 3 target vessels in 47 cases and 2 target vessels in 15 cases. Sixty one patients were relieved and one died of low cardiac output syndrome. Cases were followed up for 3 to 36 months. No angina pectoris and mortality was observed.Conclusion The technique could avoid the deficit of cardiopulmonary bypass and heart arrest. The muscle of the heart can get blood supply as soon as bridge vessels anastomosed. It is safer and effective.