Vlassov G P, Ermolov A S, Deyneka K S, Travine N O, Belinskiy M B, Klimovskiy S D, Zhuravlev I V
Sclifosovsky Research Emergency Center, Moscow, Russia.
Heart Surg Forum. 1999;2(4):305-9.
Interest in minimally invasive coronary artery bypass (MICAB) grafting and the MICAB experience have been increasing. The purpose of this study was to develop the multivessel minimally invasive coronary revascularization technique and to estimate the effectiveness of the endoscopic support in this operation.
From January 1998 through April 1999, 190 patients (ages 38 to 72 years) underwent coronary revascularization without cardiopulmonary bypass. Among them, 69 patients (55 males, 14 females) underwent minimally invasive coronary revascularization, from 1 to 3 vessels, through minithoracotomy and ministernotomy with endoscopically dissected internal mammary artery, gastroepiploic artery, and composite grafts. Preoperative risk factors included unstable angina (n = 15), reoperations (n = 8), low ejection fraction (n = 14), renal insufficiency (n = 4), chronic obstructive pulmonary disease (n = 6), cerebrovascular accident (n = 2), diffuse atherosclerosis (n = 4) and diabetes mellitus (n = 7).
The operative mortality was 1.5% (1/69). Morbidity included wound infections (n = 1), reoperation for management of bleeding (n = 1), acute graft occlusion (n = 1), perioperative myocardial infarction (n = 1). The number of grafts placed in 69 patients was as follows: single, 54; double, 10; triple, 5. Postoperative angiography and Doppler flow assessment of the coronary anastomoses performed in 22 patients (30%) showed that 97% were patent.
The minimally invasive direct coronary artery bypass grafting operation is safe and effective. Endoscopic support makes the use of minimally invasive technology possible in patients with multivessel coronary disease and makes this operation less traumatic.
对微创冠状动脉搭桥术（MICAB）的关注以及相关经验一直在增加。本研究的目的是开发多支血管微创冠状动脉血运重建技术，并评估该手术中内镜辅助的有效性。
1998年1月至1999年4月，190例年龄在38至72岁之间的患者接受了非体外循环冠状动脉血运重建术。其中，69例患者（55例男性，14例女性）通过小切口开胸和胸骨下段小切口，采用内镜下分离的胸廓内动脉、胃网膜动脉及复合移植物，进行了1至3支血管的微创冠状动脉血运重建术。术前危险因素包括不稳定型心绞痛（n = 15）、再次手术（n = 8）、射血分数低（n = 14）、肾功能不全（n = 4）、慢性阻塞性肺疾病（n = 6）、脑血管意外（n = 2）、弥漫性动脉粥样硬化（n = 4）和糖尿病（n = 7）。
手术死亡率为1.5%（1/69）。并发症包括伤口感染（n = 1）、因出血再次手术（n = 1）、急性移植物闭塞（n = 1）、围手术期心肌梗死（n = 1）。69例患者植入的移植物数量如下：单支，54例；双支，10例；三支，5例。对22例患者（30%）进行的术后冠状动脉吻合口血管造影和多普勒血流评估显示，97%的吻合口通畅。
微创直接冠状动脉搭桥术安全有效。内镜辅助使多支血管冠状动脉疾病患者能够采用微创技术，且使该手术创伤更小。
