Ducko C T, Stephenson E R, Sankholkar S, Damiano R J
Section of Cardiothoracic and Vascular Surgery, The Milton S. Hershey Medical Center, Penn State Geisinger Health System, Hershey, PA 17033, USA.
Heart Surg Forum. 1999;2(1):29-37.
Endoscopic coronary artery bypass grafting (ECABG) has not been possible with traditional techniques. This report details our animal experience determining the feasibility of using a robotically-assisted microsurgical system to perform ECABG.
Following preliminary work using a cadaveric pig heart model, acute and chronic animal studies were performed. Calves were placed on cardiopulmonary bypass after the left internal mammary artery (LIMA) was harvested. Subxiphoid endoscopic ports (2 instrument, 1 camera) were placed and a robotic system was used to perform ECABG between the LIMA and left anterior descending coronary artery. LIMA graft flow (LIMAQ) was measured, and excised hearts underwent angiographic and histologic analyses.
All anastomoses were successfully completed in both the acute and chronic studies (mean time of 33.9 +/- 1.9 and 33.2 +/- 3.4 minutes, respectively). Angiographic patency was 100% in both the acute (8/8) and chronic (6/6) studies, which was confirmed by histology. In the chronic study, there was no difference in LIMAQ between intraoperative and autopsy measurements.
This study shows that ECABG is feasible in an animal model with excellent results. The FDA has recently given approval for clinical trials of this new technology.
传统技术无法实现内镜下冠状动脉旁路移植术（ECABG）。本报告详细介绍了我们通过动物实验确定使用机器人辅助显微手术系统进行ECABG的可行性。
在使用尸体猪心脏模型进行初步工作之后，开展了急性和慢性动物研究。在获取左乳内动脉（LIMA）后，将小牛置于体外循环。放置剑突下内镜端口（2个器械端口、1个摄像端口），并使用机器人系统在LIMA与左冠状动脉前降支之间进行ECABG。测量LIMA移植物血流（LIMAQ），切除的心脏进行血管造影和组织学分析。
急性和慢性研究中的所有吻合均成功完成（平均时间分别为33.9±1.9分钟和33.2±3.4分钟）。急性（8/8）和慢性（6/6）研究中的血管造影通畅率均为100%，组织学检查证实了这一点。在慢性研究中，术中测量与尸检测量的LIMAQ无差异。
本研究表明，ECABG在动物模型中是可行的，且效果良好。美国食品药品监督管理局（FDA）最近已批准对这项新技术进行临床试验。
