Diegeler A
Klinik für Herzchrurgie, Universität Leipzig, Herzzentrum, Russenstrasse 19, 04289 Leipzig, Germany.
Curr Cardiol Rep. 1999 Nov;1(4):323-30. doi: 10.1007/s11886-999-0058-0.
New surgical techniques for the treatment of the isolated lesion of the left anterior descending coronary artery (LAD) include off-pump surgery, minimal access to the heart, and endoscopic or computer enhanced coronary artery bypass surgery. The term minimally invasive direct coronary artery bypass surgery (MIDCAB) is related to a left-side minithoracotomy, the harvest of the left internal mammary artery (IMA) under direct vision, and an anastomosis performed between IMA and LAD under direct vision, using the technique of mechanical local immobilization by a special device. Alternative techniques include endoscopic harvesting of the IMA, or as a new and still experimental approach, the closed-chest total endoscopic coronary artery bypass grafting (TECAB) with the use of a high tech telemanipulator system. The currently reported results demonstrate the safety of MIDCAB surgery (30-day mortality < 0.5%, perioperative myocardial infarction < 2%, early patency rate between 95% and 98%). Mid-term results after 6 months have shown a patency rate between 94% and 97%, and more than 90% of the patients are without any angina symptoms. Due to this promising results MIDCAB is an alternative treatment for high-grade LAD lesions.
治疗左前降支冠状动脉（LAD）孤立性病变的新手术技术包括非体外循环手术、心脏微创入路以及内镜或计算机辅助冠状动脉搭桥手术。微创直接冠状动脉搭桥手术（MIDCAB）这一术语与左侧小切口开胸、直视下获取左乳内动脉（IMA）以及使用特殊装置进行机械局部固定技术在直视下在IMA和LAD之间进行吻合有关。替代技术包括内镜下获取IMA，或者作为一种新的仍处于实验阶段的方法，即使用高科技远程操作器系统进行全内镜下冠状动脉搭桥术（TECAB）。目前报道的结果表明MIDCAB手术是安全的（30天死亡率<0.5%，围手术期心肌梗死<2%，早期通畅率在95%至98%之间）。6个月后的中期结果显示通畅率在94%至97%之间，超过90%的患者无任何心绞痛症状。鉴于这些有前景的结果，MIDCAB是治疗LAD高级别病变的一种替代治疗方法。
