Gill I S, Higginson L A, Maharajh G S, Keon W J
Department of Cardiothoracic Surgery, University of Ottawa Heart Institute, Ontario, Canada.
Ann Thorac Surg. 2000 Jan;69(1):56-60. doi: 10.1016/s0003-4975(99)00861-9.
This study was undertaken to assess the early and late outcome of coronary anastomosis constructed on a beating heart without the help of mechanical stabilization.
All consecutive patients (51) from January 1996 to September 1997 who had bypass done by one surgeon using a left minithoracotomy (39) or median sternotomy (12) on a beating heart with occlusive local snares without mechanical stabilization underwent follow-up angiography early (100%) (within 6 hours) and late (63.5%) at a mean of 9.6+/-4.48 months (range, 3.3 to 19.1 months).
The cumulative late patency was 95.4% (83 of 87 patients), with two early and two late occlusions. There was no early or late mortality or perioperative myocardial infarction. Two patients (3.9%) developed recurrent angina. Four anastomotic irregularities (4 of 32 patients, 12.6%) have cleared up on follow-up angiography. There was no evidence of late stenosis at the snare sites used for local occlusion.
Minimally invasive coronary bypass is safe and effective. Early angiographic abnormalities should be interpreted with caution and we could not demonstrate any long-term deleterious effects of local snaring.
本研究旨在评估在无机械稳定辅助的情况下，在跳动心脏上进行冠状动脉吻合术的早期和晚期结果。
1996年1月至1997年9月期间，由一名外科医生采用左胸小切口（39例）或正中胸骨切开术（12例），在跳动心脏上使用局部闭塞圈套器且无机械稳定辅助进行搭桥手术的所有连续患者（51例）均接受了早期（100%）（6小时内）和晚期（63.5%）的随访血管造影，平均随访时间为9.6±4.48个月（范围为3.3至19.1个月）。
累积晚期通畅率为95.4%（87例患者中的83例），有2例早期闭塞和2例晚期闭塞。无早期或晚期死亡或围手术期心肌梗死。2例患者（3.9%）出现复发性心绞痛。4例吻合口不规则（32例患者中的4例，12.6%）在随访血管造影时已消失。在用于局部闭塞的圈套部位未发现晚期狭窄的证据。
微创冠状动脉搭桥术安全有效。对早期血管造影异常应谨慎解读，且我们未发现局部圈套有任何长期有害影响。
