Enclose Ⅱ主动脉近端吻合器在升主动脉钙化的非体外循环下冠状动脉旁路移植术中的应用

Application of Enclose Ⅱ aortic proximal anastomosis device during off-pump coronary artery bypass grafting in patients with ascending aortic calcification

目的 评价EncloseⅡ主动脉近端吻合器在升主动脉钙化的非体外循环下冠状动脉旁路移植术（OPCABG）中应用的临床效果。方法 入选2008年3月至2015年5月,在首都医科大学附属北京友谊医院行冠状动脉旁路移植术且升主动脉严重钙化的患者435例。在施行OPABG行主动脉近端吻合时使用吻合装置EncloseⅡ系统吻合。观察患者吻合后桥血管血流及术中术后相关并发症发生情况。结果 本组患者术后死亡5例（1.15%）,其中3例并发严重低心排综合征,2例呼吸衰竭并发严重肺部感染死亡。术中搭桥2-5支,平均（3.11±0.08）支,使用主动脉近端吻合器做近端吻合口561个,其中大隐静脉（GSV）吻合口458个,桡动脉（RA）吻合口103个,吻合完成后使用流量仪测定桥血管流量（22.15±7.26）ml/min,与同期使用侧壁钳者相比无明显差别（P〉0.05）。术中及术后均未发生与使用吻合器的相关并发症。结论 EncloseⅡ主动脉近端吻合器使用方便,安全可靠。可有效减少因主动脉近端操作导致的相关并发症发生。

Objective To review the clinical application effect of Enclose Ⅱ aortic proximal anastomosis device（Enclose Ⅱ） during off-pump coronary artery bypass grafting（OPCABG） in patients with ascending aortic calcification. Methods The patients with serious aortic calcification（n=435） undergone OPCABG were chosen from Mar. 2008 to May 2015. Enclose Ⅱ was applied for aortic proximal anastomosis during OPCABG. The graft flow after anastomosis and incidence of complications were observed during and after anastomosis. Results There were 5 cases（1.15%） died after OPCABG, among them 3 with serious low cardiac output syndrome, and 2 with respiratory failure complicating severe pulmonary infection. There were 2-5（average 3.11±0.08） bypass grafting completed in OPCABG, 561 proximal anastomotic stomas completed by using Enclose Ⅱ, including 458 anastomotic stomas of great saphenous vein（GSV） and 103 of radial artery（RA）. After proximal anastomosis by using Enclose Ⅱ, graft flow [（22.15±7.26） m L/min] had no significant difference compared with that after using aorta side wall clamp（P〉0.05）. There were no complications related to Enclose Ⅱ during and after OPCABG. Conclusion Enclose Ⅱ is easy to use, safe and reliable, which can effectively reduce the complications related to aortic proximal operation.