Douville E C, Handy J R, Tsen A C, Ott G Y, Gilbert M, Asaph J W
The Oregon Clinic and Providence Portland Medical Center, Portland, OR, USA.
Heart Surg Forum. 1999;2(1):41-6.
Minimally invasive direct coronary artery bypass (MIDCAB) has been criticized as compromising anastomotic patency. Epicardial mechanical stabilization devices purportedly facilitate left internal mammary artery (LIMA) anastomosis, thereby enhancing patency and outcome.
From June 1996 through January 1999, 39 patients underwent MIDCAB via a small left anterior thoracotomy for revascularization of the left anterior descending coronary artery (LAD) without cardiopulmonary bypass (CPB). Immediate postoperative coronary angiography was performed on 38 of the patients.
Group 1 consisted of 11 patients who were operated upon without epicardial stabilization. Mean age was 64 years. Two had undergone previous coronary artery bypass (CAB). Predicted mortality was 4.3%. Angiographic anastomotic patency was 60%. Revisions on CPB in three cases increased LIMA patency to 90%. There was one intra-operative death. Average length of stay (LOS) was 5.4 days. Group 2 consisted of 28 patients operated on with mechanical epicardial stabilization. Predicted risk of mortality was 4.4%. Mean age was 66 years. Twelve had undergone previous CAB. Anastomotic patency at angiography was 97.4%. There were no intra-operative deaths and mean LOS was 3.0 days.
We conclude that mechanical epicardial stabilization has transformed the MIDCAB operation into one that offers excellent early patency and clinical outcomes. This operation is of particular value for revascularization of the anterior coronary circulation in patients with previous CAB; clinical results are significantly better than predicted for standard redo-CAB.
微创直接冠状动脉旁路移植术（MIDCAB）一直被批评存在吻合口通畅性不佳的问题。心外膜机械稳定装置据称有助于左乳内动脉（LIMA）吻合，从而提高通畅率和手术效果。
从1996年6月至1999年1月，39例患者通过左前外侧小切口接受MIDCAB，用于左前降支冠状动脉（LAD）血运重建，无需体外循环（CPB）。38例患者术后立即进行了冠状动脉造影。
第1组由11例未用心外膜稳定装置进行手术的患者组成。平均年龄为64岁。2例曾接受过冠状动脉旁路移植术（CAB）。预计死亡率为4.3%。血管造影显示吻合口通畅率为60%。3例在CPB下行修正手术，使LIMA通畅率提高到90%。有1例术中死亡。平均住院时间（LOS）为5.4天。第2组由28例使用心外膜机械稳定装置进行手术的患者组成。预计死亡风险为4.4%。平均年龄为66岁。12例曾接受过CAB。血管造影时吻合口通畅率为97.4%。无术中死亡，平均LOS为3.0天。
我们得出结论，心外膜机械稳定装置已将MIDCAB手术转变为一种具有出色早期通畅率和临床效果的手术。该手术对于既往接受过CAB的患者进行前冠状动脉循环血运重建具有特别价值；临床结果明显优于标准再次CAB的预期。
