Milani Rodrigo, Brofman Paulo Roberto Slud, Souza José Augusto Moutinho de, Barboza Laura, Guimarães Maximiliano Ricardo, Barbosa Alexandre, Varela Alexandre Manoel, Ravagnelli Marcel Rogers, Silva Francisco Maia da
Santa Casa de Misericórdia de Curitiba - PUC/PR.
Rev Bras Cir Cardiovasc. 2007 Jul-Sep;22(3):310-6. doi: 10.1590/s0102-76382007000300007.
To evaluate the immediate results of mechanical aorto-saphenous anastomosis compared with conventional anastomosis.
We evaluated 12 patients. The mean age ranged from 62.33 +/- 7.30 years. Of 12 patients submitted to surgery without extracorporeal circulation, 10 (83.3%) patients were male. Thirty-three proximal anastomoses were evaluated, 21 of them being performed through the conventional manner and 12 with the St. Jude Symmetry aortic connector. The time spent on anastomosis, and free flow and patency on the 4th day postoperative were analysed.
The mechanical anastomosis was successfully performed in all patients. Electrocardiographic alteration compatible with myocardial infarctation (MI) on the 2nd day postoperative was observed only in one patient. The patient was referred to angiographic restudy, becoming evident a conventional proximal anastomosis occlusion for the marginal branch. Three patients had atrial fibrillation. The average time spent to perform the mechanical anastomosis was 44.08 +/- 9.26 seconds against 3.86 +/- 0.61 minutes of the conventional anastomosis (p = 0.0022). The average blood free flow observed in the mechanical anastomosis was 302.75 +/- 82.76 mL/min versus 190.75 +/- 51.53 mL/min (p = 0.0022). In the angiographic restudy performed on the 4th postoperative day, it was detected the occlusin of three mechanical anastomosis. There was no new conventional anastomosis (p = 0.2500).
The present study showed a statistically significant superiority for mechanical anastomosis of the saphenous vein with the aorta when evaluated the blood free flow and the time to perform the anastomosis. In relation to the artery condition in the postoperative angiography, one cannot say there was statistically significant difference between the procedures studied.
评估机械性主动脉-大隐静脉吻合术与传统吻合术的近期效果。
我们评估了12例患者。平均年龄为62.33±7.30岁。在12例接受非体外循环手术的患者中，10例（83.3%）为男性。评估了33处近端吻合术，其中21处采用传统方式进行，12处使用圣犹大Symmetry主动脉连接器。分析了吻合时间、术后第4天的自由血流和通畅情况。
所有患者均成功完成机械吻合术。仅1例患者在术后第2天出现与心肌梗死（MI）相符的心电图改变。该患者接受血管造影复查，发现边缘支传统近端吻合口闭塞。3例患者出现房颤。机械吻合术的平均操作时间为44.08±9.26秒，而传统吻合术为3.86±0.61分钟（p = 0.0022）。机械吻合术中观察到的平均自由血流为302.75±82.76 mL/分钟，而传统吻合术为190.75±51.53 mL/分钟（p = 0.0022）。在术后第4天进行的血管造影复查中，发现3处机械吻合口闭塞。未发现新的传统吻合口闭塞（p = 0.2500）。
本研究表明，在评估自由血流和吻合时间时，大隐静脉与主动脉的机械吻合术具有统计学上的显著优势。关于术后血管造影中的动脉情况，无法说所研究的手术之间存在统计学上的显著差异。
