全动脉化微创伤冠脉旁路手术临床应用

Total arterial myocardial revascularization with minimally invasive beating heart surgery for coronary artery bypass grafting

目的 :评价全动脉化冠状动脉 (冠脉 )旁路移植手术和微创伤冠脉旁路手术技术联合应用的临床效果。方法 :12例病人采用非体外循环冠脉旁路手术方法 ,应用右乳内动脉、左乳内动脉及左游离桡动脉行全动脉化旁路手术。结果 :全组无住院死亡。手术中搭桥1～ 4支 ,平均 2 .6支 ;平均手术时间 (切皮至缝皮 ) 12 1.2min ;术后平均机械辅助通气时间4.3h ,平均ICU监护时间 12h ,平均住院时间 8.9d。随访 1～ 12个月 ,所有患者心绞痛症状消失。结论 :全动脉化微创伤非体外循环冠脉旁路手术结合了两种手术技术的优点 ,具有创伤小、恢复快、动脉搭桥术后长期通畅率高的特点 。

Objective To evaluate the clinical outcomes of combination of total arterial myocardial revascularization with off-pump coronary artery bypass grafting technique.Methods 12 male patients ageing between 46 to 65 years old underwent off-pump coronary artery bypass grafting(OPCAB) by using right internal mammary artery,left internal mammary artery and free left radial artery for total arterial myocardial revascularization.Mostly single or triple vessels diseases were envolved,including left main coronary artery in two patients.The cardiac function was between Ⅱ to Ⅲ class.Results There was no hospital mortality.An averaged 2.6 grafts(1 to 4) were performed in operation,with operation time (skin to skin) 121.2 min and an average mechanical ventilating time 4.3 h.The patients stayed in ICU for 12 h,in hospital for 8.9 d on average.All patients' angina disappeared during the 1 to 12 months follow-up.Conclusions Total arterial myocardial revascularization with OPCAB has combined the advantages of the two techniques,which has the characteristics of minimally invasive surgery,quick recovery,and the good clinical outcomes of long-term patency.We recommend the technique for coronary artery bypass grafting.