Minato Naoki, Okada Takayuki, Kanemoto Shinya, Zempo Nobuya
Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
Surg Today. 2018 May;48(5):566-570. doi: 10.1007/s00595-017-1623-6. Epub 2018 Jan 9.
We present a segmental clamp with distal perfusion technique to reduce myocardial ischemia during onlay grafting, on a beating heart. After a proximal coronary arteriotomy for 2-3 cm, the distal artery is perfused through a cannula, with femoral arterial blood (distal perfusion with external shunt). During proximal and distal coronary snare clamping with distal perfusion, onlay anastomosis is performed, from the heel toward the point of cannula insertion. We then move the proximal clamp to the onlay area and open the graft, to get early proximal coronary reperfusion. The arteriotomy is extended, and this procedure is repeated to achieve complete beating heart onlay anastomosis. We safely performed this procedure on the beating heart off-pump or on-pump in 95 patients with no perioperative myocardial infarction, no intraoperative hemodynamic deterioration, no 30-day mortality. This technique reduces regional myocardial ischemic and secures the safety for onlay grafting on the beating heart.
我们介绍一种在跳动心脏上进行覆盖移植时减少心肌缺血的节段性夹闭及远端灌注技术。在近端冠状动脉切开2 - 3厘米后，通过一根插管利用股动脉血对远端动脉进行灌注（带外部分流的远端灌注）。在进行远端灌注的近端和远端冠状动脉圈套夹闭期间，从吻合口根部向插管插入点进行覆盖吻合。然后将近端夹移至覆盖区域并打开移植物，以实现早期近端冠状动脉再灌注。延长动脉切口，并重复此过程以完成跳动心脏上的完全覆盖吻合。我们在95例患者中安全地在非体外循环或体外循环下的跳动心脏上实施了该手术，无围手术期心肌梗死、无术中血流动力学恶化、无30天死亡率。该技术减少了局部心肌缺血，并确保了在跳动心脏上进行覆盖移植的安全性。
