Wittwer T, Cremer J, Wahlers T, Mügge A, Heublein B, Pethig K, von Leitner E R, Hepp A, Wehr M, Drexler H, Haverich A
Klinik für Thorax-, Herz- und Gefässchirurgie Medizinische Hochschule Hannover.
Z Kardiol. 1999 Jul;88(7):481-8. doi: 10.1007/s003920050312.
Minimally invasive direct coronary artery bypass (MIDCAB) grafting without cardiopulmonary bypass (CPB) through an anterolateral minithoracotomy has become a promising therapeutical option especially in multimorbid, elderly and reoperative patients with single vessel disease. However, this procedure precludes complete revascularization in multivessel disease because the minithoracotomy limits the surgical access either to anterior or lateral or posterior vessels of the beating heart. To expand the benefits of the MIDCAB concept to patients with multivessel disease, new interdisciplinary approaches have recently been introduced.
Since December 1996, 26 patients (21 male, 5 female, mean age 56.6 +/- 18.8 years) underwent a "hybrid" revascularization performed as a primary MIDCAB procedure for grafting of the left anterior descending artery (LAD) with the left internal mammary artery (LIMA) followed by staged angioplasty and stenting of additional coronary lesions.
After MIDCAB grafting, the postoperative course was uneventful in all patients. Coronary re-angiography after a median of 7 days revealed patent and functioning LIMA grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty (PTCA) and occasional stenting (n = 8), a total of 31 lesions were treated successfully. Procedure related complications did not occur. All patients remained angina-free and no stress electrocardiographic changes were recorded.
Our preliminary results of a "hybrid" approach to myocardial revascularization suggest that this concept is a safe and effective approach of complete revascularization for selected patients with multivessel involvement. Especially elderly and reoperative patients with significant comorbidity may benefit from hybrid procedures avoiding cardiopulmonary bypass and midsternotomy.
通过前外侧小切口进行的非体外循环下微创直接冠状动脉旁路移植术（MIDCAB）已成为一种有前景的治疗选择，尤其适用于患有单支血管病变的多病、老年和再次手术患者。然而，该手术无法实现多支血管病变的完全血运重建，因为小切口限制了对跳动心脏的前侧、外侧或后侧血管的手术入路。为了将MIDCAB概念的益处扩展到多支血管病变患者，最近引入了新的跨学科方法。
自1996年12月以来，26例患者（21例男性，5例女性，平均年龄56.6±18.8岁）接受了“杂交”血运重建，作为主要的MIDCAB手术，用左乳内动脉（LIMA）移植左前降支动脉（LAD），随后分期对其他冠状动脉病变进行血管成形术和支架置入术。
MIDCAB移植术后，所有患者的术后过程均顺利。中位7天后的冠状动脉造影显示所有患者的LIMA移植物通畅且功能良好。应用后续的经皮腔内冠状动脉成形术（PTCA）并偶尔进行支架置入术（n = 8），共成功治疗了31处病变。未发生与手术相关的并发症。所有患者均无心绞痛，且未记录到应激心电图变化。
我们对心肌血运重建的“杂交”方法的初步结果表明，这一概念对于选定的多支血管受累患者是一种安全有效的完全血运重建方法。尤其是患有严重合并症的老年和再次手术患者可能受益于避免体外循环和正中胸骨切开术的杂交手术。
