非体外循环下采用局部稳定技术的钝缘支血管移植术：再次手术的开胸入路
Off-pump obtuse marginal grafting with local stabilization: thoracotomy approach in reoperations.
作者信息
Baumgartner F J, Gheissari A, Panagiotides G P, Capouya E R, Declusin R J, Yokoyama T
机构信息
St. Vincent Medical Center, Los Angeles, USA.
出版信息
Ann Thorac Surg. 1999 Sep;68(3):946-8. doi: 10.1016/s0003-4975(99)00683-9.
BACKGROUND
Redo coronary surgery in patients with patent internal mammary artery (IMA) grafts may be hazardous. A thoracotomy approach has been used to graft the circumflex branches to avoid injury from sternal re-entry. Combining this approach with off-pump revascularization techniques may be useful.
METHODS
Seven consecutive patients who had undergone prior coronary revascularization developed symptoms attributable to lateral wall ischemia. Five of them had patent IMA grafts. These patients underwent off-pump obtuse marginal grafting using local immobilization techniques via a thoracotomy approach. Inflow was from the descending aorta in 6 patients and splenic artery in 1.
RESULTS
Obtuse marginal grafting was successfully performed in all cases without need for cardiopulmonary bypass.
CONCLUSIONS
Off-pump obtuse marginal grafting via the thoracotomy route may be useful in redo coronary surgery, particularly in instances of patent IMA grafts.
背景
对于乳内动脉（IMA）移植血管仍通畅的患者，再次进行冠状动脉手术可能具有危险性。已采用开胸入路来移植回旋支以避免胸骨再次切开造成的损伤。将这种入路与非体外循环血管重建技术相结合可能会有用。
方法
7例曾接受过冠状动脉血运重建的连续患者出现了归因于侧壁缺血的症状。其中5例患者的IMA移植血管通畅。这些患者通过开胸入路采用局部固定技术接受了非体外循环钝缘支移植术。6例患者的血流来自降主动脉，1例来自脾动脉。
结果
所有病例均成功完成钝缘支移植，无需体外循环。
结论
通过开胸途径进行非体外循环钝缘支移植术在再次冠状动脉手术中可能有用，特别是在IMA移植血管通畅的情况下。
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