Wolf Randall K, Alderman Edwin L, Caskey Michael P, Raczkowski Allen R, Dullum Mercedes K, Lundell Dwight C, Hill Arthur C, Wang Nan, Daniel Michael A
Ohio State University, Columbus, Ohio 43210, USA.
J Thorac Cardiovasc Surg. 2003 Jul;126(1):168-77; discussion 177-8. doi: 10.1016/s0022-5223(03)00234-4.
To evaluate the safety and effectiveness of a self-closing surgical clip with an interrupted technique in left internal thoracic artery to left anterior descending artery bypass grafting.
Eighty-two patients were enrolled and treated (February 2000 through August 2001) in a prospective, nonrandomized, multicenter trial. Left internal thoracic artery to left anterior descending artery anastomoses were performed in 60 off-pump coronary artery bypasses (73%), 12 conventional coronary artery bypass grafting (15%), and 10 minimally invasive direct coronary artery bypass (12%) procedures. Angiograms (64 to 383 days, mean 200 days) were obtained on 63 patients (77%). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory.
The self-closing surgical clip was used for 82 left internal thoracic artery to left anterior descending artery interrupted anastomoses without the requirement for knot tying or primary suture management. Minimum left internal thoracic artery to left anterior descending artery anastomosis time was 3 minutes. There was one perioperative and one late death (both not heart related) and one reexploration for bleeding unrelated to the anastomotic site. FitzGibbon grades were as follows: A (n = 60, 95.2%), B (n = 3, 4.8%) including one kinked left internal thoracic artery, and O (n = 0, 0%). Quantitative analysis (n = 57) showed mean lumen diameters of left internal thoracic artery proximal to the anastomosis of 2.1 mm, at anastomosis of 2.0 mm, and in the left anterior descending artery distal to the anastomosis of 1.9 mm. The average ratio of the anastomosis to the left anterior descending artery diameter was 1.14 (0.45 to 1.93). Anastomotic stenosis as a percentage of average left internal thoracic artery to left anterior descending artery diameter was -2.3%, comparing favorably with results (23% to 24%) reported from the Patency, Outcomes, Economics, Minimally invasive direct coronary artery (POEM) bypass study.
The interrupted technique, facilitated by a self-closing anastomotic clip, yields favorable 6-month angiographic results when compared with other published studies.
评估在左胸廓内动脉至左前降支动脉搭桥术中使用间断技术的自闭合手术夹的安全性和有效性。
82例患者（2000年2月至2001年8月）纳入一项前瞻性、非随机、多中心试验并接受治疗。60例（73%）患者接受非体外循环冠状动脉搭桥术，12例（15%）接受传统冠状动脉搭桥术，10例（12%）接受微创直接冠状动脉搭桥术，均进行左胸廓内动脉至左前降支动脉吻合。63例（77%）患者在术后64至383天（平均200天）进行了血管造影。由独立核心实验室进行定性和定量血管造影评估。
自闭合手术夹用于进行82例左胸廓内动脉至左前降支动脉的间断吻合，无需打结或进行初级缝合处理。左胸廓内动脉至左前降支动脉的最短吻合时间为3分钟。围手术期死亡1例，晚期死亡1例（均与心脏无关），1例因与吻合部位无关的出血进行了再次探查。菲茨吉本分级如下：A级（n = 60，95.2%），B级（n = 3，4.8%），其中1例左胸廓内动脉扭曲，O级（n = 0，0%）。定量分析（n = 57）显示，吻合口近端左胸廓内动脉平均管腔直径为2.1mm，吻合处为2.0mm，吻合口远端左前降支动脉为1.9mm。吻合口与左前降支动脉直径的平均比值为1.14（0.45至1.93）。吻合口狭窄占左胸廓内动脉至左前降支动脉平均直径的百分比为 -2.3%，优于通畅性、结果、经济学、微创直接冠状动脉（POEM）搭桥研究报告的结果（23%至24%）。
与其他已发表的研究相比，在自闭合吻合夹辅助下的间断技术可产生良好的6个月血管造影结果。
