微创左胸小切口全动脉化多支冠状动脉旁路移植术的应用体会

Minimally invasive total arterial graft revascularization via a left minithoracotomy for multivessel coronary artery dis-ease

目的：探讨乳内动脉（ LIMA）-桡动脉（ RA）全动脉化复合旁路移植血管在微创左胸小切口多支冠状动脉旁路移植术的应用，评价其效果。方法2009年1月至2015年9月期间在微创左胸小切口多支冠状动脉旁路移植术中应用LIMA-RA全动脉化复合旁路移植血管治疗冠心病患者39例，男24例，女15例；年龄35～75岁，平均（65.2±7.2）岁。患者均经左胸前侧第4肋间切口，在非体外循环下行微创直视冠状动脉旁路移植（ MIDCAB）术。结果患者均顺利应用LIMA-RA全动脉化复合旁路移植血管完成MIDCAB术，无术中中转为正中开胸。平均手术（176.1±14.1） min（158～203 min）。靶血管再血管化数为2支11例，3支25例，4支3例。全组吻合口共109个，其中LIMA-LAD（左前降支）吻合口39个，RA吻合口70个。术后机械通气6～162 h，平均（21.9±27.9） h；术后ICU停留2～14天，平均（2.8±2.1）天；术后住院7～25天，平均（11.2±3.3）天。围手术期无死亡。平均术后随访（27.5±18.0）个月（6～86个月），全组死亡1例，术后2年累积生存率（96.0±3.9）％。全组患者LIMA-LAD吻合口通.率100％，RA旁路移植血管吻合口阻塞4个（5.7％），术后2年累积RA旁路移植血管通.率（91.8±4.0）％。结论 LIMA-RA全动脉化复合旁路移植血管可安全地应用于微创左胸小切口多支冠状动脉旁路移植术中，早、中期治疗效果满意。

Objective To evaluate the outcomes achieved by using left internal mammary artery（LIMA） to radial artery （RA） total arterial composite grafts in minimally invasive direct coronary artery bypass grafting （MIDCAB） for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients（24 males） with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was（176.1 ± 14.1）min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was（21.9 ±27.9） h.Mean ICU time was（2.8 ±2.1） days, and mean postoper-ative inhosptial time was（11.2 ±3.3）days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age（27.5 ±18.0） months], one patient died.The overall survival at 2 years postoperatively was（96.0 ±3.9）%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was（91.8 ±4.0）%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .