Gulielmos V, Wagner F M, Waetzig B, Solowjowa N, Tugtekin S M, Schroeder C, Schueler S
Cardiovascular Institute, University of Dresden, Fetscherstrasse 76, D-01307 Dresden, Germany.
World J Surg. 1999 May;23(5):480-5. doi: 10.1007/pl00012335.
To minimize surgical trauma, the use of Port Access cardiac surgery was initiated in patients (pts) with coronary artery disease (CAD) (42 pts) or mitral valve disease (MVD) (24 pts) in March 1996 at our institution. Altogether 42 pts (36 men, 6 women; age 31-75 years, median 59.0 years) with isolated lesions of the left anterior descending (LAD) artery underwent Port Access coronary artery surgery (PACAS). A small (5-9 cm) incision was done parasternally on top on the fourth rib. The left internal mammary artery (LIMA) was dissected through the minithoracotomy or by using an additional thoracoscopic approach. A total of 24 pts (12 men, 12 women; age 30-75 years, median 62 years) underwent Port Access mitral valve surgery (PAMVS). In these pts the procedure was performed through a small right thoracotomy (6-8 cm). In all cases, endovascular cardiopulmonary bypass (CPB) was instituted through femoral cannulation, and an additional endoaortic balloon catheter was introduced into the ascending aorta for aortic occlusion. In pts with PACAS the survival was 98% (41/42) and in the PAMVS group 100%. All pts but one survived the PACAS and are well today. There were no deaths in the PAMVS group. The hospital stay was reduced by 1 day on average after PACAS and 3 days after PAMVS. Thus in well selected patients Port Access cardiac surgery represents a safe and feasible minimally invasive surgical approach that avoids the potential complications of a sternotomy while offering the advantages and safety of CPB and cardioplegic arrest. This minimally invasive approach offers a shortened hospital stay and earlier rehabilitation.
为将手术创伤降至最低，1996年3月我们机构开始对冠心病（CAD）患者（42例）或二尖瓣疾病（MVD）患者（24例）采用端口入路心脏手术。共有42例（36例男性，6例女性；年龄31 - 75岁，中位年龄59.0岁）孤立性左前降支（LAD）动脉病变患者接受了端口入路冠状动脉手术（PACAS）。在第四肋上方胸骨旁做一个小（5 - 9厘米）切口。通过小切口开胸或使用额外的胸腔镜方法解剖左乳内动脉（LIMA）。共有24例（12例男性，12例女性；年龄30 - 75岁，中位年龄62岁）患者接受了端口入路二尖瓣手术（PAMVS）。在这些患者中，手术通过小的右胸切口（6 - 8厘米）进行。在所有病例中，通过股动静脉插管建立血管内体外循环（CPB），并将一个额外的主动脉内球囊导管插入升主动脉进行主动脉阻断。在接受PACAS的患者中，生存率为98%（41/42），在PAMVS组中为100%。除1例患者外，所有接受PACAS的患者均存活且目前状况良好。PAMVS组无死亡病例。PACAS后平均住院时间缩短1天，PAMVS后缩短3天。因此，对于精心挑选的患者，端口入路心脏手术是一种安全可行的微创手术方法，可避免胸骨切开术的潜在并发症，同时提供CPB和心脏停搏的优点及安全性。这种微创方法可缩短住院时间并促进早期康复。
