Schachner Thomas, Bonaros Nikolaos, Laufer Günther, Bonatti Johannes
Department of Cardiac Surgery, Innsbruck University Hospital, Innsbruck, Austria.
Heart Surg Forum. 2004;7(6):E632-5. doi: 10.1532/HSF98.20041106.
Peripheral access cardiopulmonary bypass (CPB) and endoclamping of the aorta are prerequisites for performance of minimal access or totally endoscopic cardiac surgery on the arrested heart. We present our experience with the ESTECH remote access perfusion (RAP) cannula in arrested-heart totally endoscopic coronary bypass grafting (AHTECAB) and atrial-septal defect (ASD) repair via minithoracotomy and totally endoscopic ASD repair.
Remote access CPB was performed in 30 patients (17 male), with a median age of 56 years (range, 21-70 years) using the ESTECH RAP cannula. Preoperatively all patients received a thoracic and abdominal CT scan. Operations were 20 AHTECAB, 5 ASD repair via minithoracotomy, and 5 robotically assisted totally endoscopic ASD repairs. Intraoperatively the patients were monitored by transesophageal echocardiography and bilateral radial artery pressure lines for correct placement of the balloon in the ascending aorta.
Neither vascular perforation nor dissection of the aorta occurred during these surgeries. Full CPB was achieved in all patients. Because of location in a supraaortic branch fluoroscopic visualization of the guide wire was necessary in 2 of 30 cases. Once the aortic occlusion balloon was placed, repositioning was required in none of our cases. In one AHTECAB case rupture of the balloon occurred before starting the anastomosis. The cannula was replaced and the AHTECAB could be finished without complications. In one patient inguinal wound infection occurred, which was successfully revised surgically. No perioperative myocardial ischemia, stroke, or critical leg ischemia occurred, and no hospital death occurred.
CPB and cardiac arrest can adequately be performed via a femoral access in minimally invasive cardiac surgery using the ESTECH RAP system. Intense preoperative patient evaluation and intraoperative monitoring are absolute prerequisites for safe application of the technique.
外周体外循环（CPB）和主动脉内阻断是在心脏停搏状态下进行微创或完全内镜心脏手术的前提条件。我们介绍了我们在使用ESTECH远程通路灌注（RAP）套管进行心脏停搏状态下完全内镜冠状动脉搭桥术（AHTECAB）以及通过小切口开胸和完全内镜修复房间隔缺损（ASD）方面的经验。
使用ESTECH RAP套管对30例患者（17例男性）进行了远程通路CPB，患者中位年龄56岁（范围21 - 70岁）。所有患者术前均接受了胸部和腹部CT扫描。手术包括20例AHTECAB、5例通过小切口开胸修复ASD以及5例机器人辅助完全内镜修复ASD。术中通过经食管超声心动图和双侧桡动脉压力监测线对患者进行监测，以确保球囊在升主动脉内的正确放置。
这些手术过程中均未发生血管穿孔或主动脉夹层。所有患者均成功实现了完全CPB。由于位于主动脉上分支，30例中有2例需要借助透视来观察导丝位置。一旦放置了主动脉阻断球囊，我们的病例中均无需重新定位。在1例AHTECAB病例中，球囊在开始吻合前破裂。更换了套管，AHTECAB得以顺利完成且无并发症发生。1例患者发生腹股沟伤口感染，经手术成功处理。未发生围手术期心肌缺血、中风或严重下肢缺血，也未出现医院死亡病例。
使用ESTECH RAP系统在微创心脏手术中通过股动脉通路能够充分实现CPB和心脏停搏。术前对患者进行全面评估以及术中进行监测是安全应用该技术的绝对必要条件。
