胸部小切口冠状动脉搭桥术

Minimally invasive direct coronary artery bypass grafting via minithoracotomy

目的 评价胸部小切口冠状动脉搭桥术的临床疗效。 方法 采用左胸部小切口取左乳内动脉 ,在心脏跳动下行冠状动脉搭桥术 141例。其中前降支单支病变 83例 ,多支病变 5 8例。合并高危因素者 5 8例 ,行经皮冠状动脉腔内成型术 (PTCA)术后 45例 ,冠状动脉搭桥术后 10例。 结果 全组均完成手术 ,其中左乳内动脉搭至前降支 139例 ,第一对角支 2例。无围术期死亡。术后行2次冠状动脉搭桥术 1例 ,PTCA 2 1例。冠状动脉造影显示血管桥通畅率 98 5 %。 结论 胸部小切口冠状动脉搭桥术主要适用于前降支的再血管化。该手术安全可靠 ,疗效优良 。

Objective To evaluate the clinical outcome of minimally invasive direct coronary artery bypass (MIDCAB). [WT5”HZ]Methods[WT5”BZ] One hundred and forty one patients were treated with MIDCAB in the beating heart using left internal mammary artery (LIMA) extracted via minithoracotomy. Their age ranged from 35 to 87 years (mean, 63 years). Eighty three patients (58 9%) had single vessel disease of the left anterior descending artery (LAD) and 58 (41 1%) had multiple vessel disease. A sufficient length of the LIMA was harvested to reach the target vessels by using a special thoracic retractor. [WT5”HZ]Results[WT5”BZ] The procedure was completed in all the patients by grafting LAD in 139 and the diagonal artery in 2. Conversion to conventional techniques was not necessary. Mean operative duration was 110 minutes. Sixty one patients (43 3%) underwent extubation in the operating room. Blood transfusion was necessary in 7 patients (5 0%). There was no perioperative death. One patient received early reoperation under extracorporeal circulation because of conduit malformation. Twenty one patients underwent percutaneous transluminal coronary artery angioplasty. All the patients were free from angina pectoris postoperatively and early graft patency was seen in 98 5% of the patients. [WT5”HZ]Conclusion[WT5”BZ] MIDCAB is safe and effective for those patients with a high risk in conventional procedures or with non satisfactory interventional outcomes.