Christensen John B, Lund Jens T, Kassis Eli, Kelbaek Henning
Department of Thoracic Surgery, Copenhagen County Hospital in Gentofte, Niels Andersens Vej 59, DK-2900 Hellerup, Denmark.
Eur J Cardiothorac Surg. 2002 Mar;21(3):391-4. doi: 10.1016/s1010-7940(01)01148-4.
Coronary artery bypass graft surgery with arterial revascularisation of all diseased coronary vessels is considered highly efficient because arterial grafts have an excellent long-term patency compared with venous grafts. However, problems to reach the infero-lateral wall with the in situ internal thoracic arteries usually require alternative techniques. We present the first results of a new surgical principle using a free radial artery segment to complete the arterial coronary revascularisation and concomitantly connect the internal thoracic arteries.
In patients referred for coronary bypass surgery and three-vessel disease an end-to-end anastomosis of the right internal thoracic artery and the radial artery segment preceded cardiopulmonary bypass, during which side-to-side anastomoses of the radial artery segment were used to revascularise stenotic branches of the right coronary and circumflex arteries. The left internal thoracic artery was used for revascularisation of stenotic branches of the left anterior descending artery, and finally an end-to-side anastomosis of the radial artery segment to the left internal thoracic artery was performed. Coronary artery blood flow was measured in 41 patients with Doppler flow probe.
One hundred and ninety-two coronary anastomoses (an average of 4.2 per patient) were performed in 46 patients. We measured a mean total blood flow in the arterial sling graft of 104ml/min (range 35-221ml/min), compared with 69 and 68ml/min of the single inlet right and left internal thoracic arteries, respectively (P<0.01). Flow capacities of 104 and 120ml/min of the right and left internal thoracic arteries were measured during clamp of both the aorta and the contralateral internal thoracic artery. The mean crossclamp duration was 77min (range 51-113min). Postoperative angiography demonstrated patent graft anastomoses to all coronary arteries. There were no perioperative deaths or myocardial infarctions. One patient had a minor postoperative stroke.
Complete arterial revascularisation can be achieved by the arterial sling operation with an acceptable crossclamp time and a high early rate of graft patency. The double arterial inlet provides a 50% higher blood flow to the beating heart and two-fold increase in the flow reserve compared with a single inlet. Although further research including long-term follow-up of this new principle is required, the present findings seem promising and suggest that the arterial sling operation has a potential role for complete arterial coronary revascularisation.
对所有病变冠状动脉血管进行动脉血运重建的冠状动脉旁路移植手术被认为效率很高，因为与静脉移植物相比，动脉移植物具有出色的长期通畅性。然而，使用原位胸廓内动脉到达下侧壁存在困难，通常需要采用替代技术。我们展示了一种新的手术原则的初步结果，即使用游离桡动脉段完成冠状动脉动脉血运重建，并同时连接胸廓内动脉。
在因冠状动脉搭桥手术和三支血管病变而转诊的患者中，在体外循环前进行右胸廓内动脉与桡动脉段的端端吻合，在此期间，桡动脉段的侧侧吻合用于为右冠状动脉和回旋支动脉的狭窄分支进行血运重建。左胸廓内动脉用于为左前降支动脉的狭窄分支进行血运重建，最后进行桡动脉段与左胸廓内动脉的端侧吻合。使用多普勒血流探头对41例患者的冠状动脉血流进行了测量。
46例患者共进行了192次冠状动脉吻合（平均每位患者4.2次）。我们测得动脉吊带移植物的平均总血流量为104ml/分钟（范围为35 - 221ml/分钟），相比之下，单入口右胸廓内动脉和左胸廓内动脉的血流量分别为69ml/分钟和68ml/分钟（P<0.01）。在主动脉和对侧胸廓内动脉夹闭期间，测得右胸廓内动脉和左胸廓内动脉的血流量分别为104ml/分钟和120ml/分钟。平均体外循环时间为77分钟（范围为51 - 113分钟）。术后血管造影显示所有冠状动脉的移植物吻合口通畅。围手术期无死亡或心肌梗死发生。1例患者术后发生轻微中风。
通过动脉吊带手术可以实现完全动脉血运重建，体外循环时间可接受，且早期移植物通畅率高。与单入口相比，双动脉入口可为跳动的心脏提供高50%的血流量，血流储备增加一倍。尽管需要进一步研究，包括对这一新原则的长期随访，但目前的研究结果似乎很有前景，表明动脉吊带手术在完全冠状动脉动脉血运重建中具有潜在作用。
