Knight J L, Cohn L H
Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115.
J Card Surg. 1987 Sep;2(3):343-9. doi: 10.1111/j.1540-8191.1987.tb00192.x.
Left thoracotomy and femoro-femoral cardiopulmonary bypass has been used for reoperation in five patients requiring coronary bypass graft into the inferolateral surface of the heart. Five patients had refractory angina pectoris and angiographic occlusion of lateral wall native vessels or previous occluded vein grafts and all had positive exercise test. Four of the five had patent internal mammary to the LAD. Following supine positioning and removal of the saphenous vein and isolation of the femoral artery and femoral vein, a left fifth interspace thoracotomy was made, the patient heparinized and cannulated for cardiopulmonary bypass, the pericardium opened, the heart dissected free, and either the internal mammary artery dissected off the left chest wall or saphenous vein grafts used to bypass the appropriate lesions. The proximal inflow was the descending thoracic aorta making tunnels for the vein grafts through the posterior pericardium. All of the patients did well in the postoperative period. This technique is recommended for reoperations in patients with documented inferolateral ischemia as the primary cause of symptomatology with mitigating circumstances against an anterior approach.
左胸廓切开术及股-股体外循环已用于5例需要在心脏下外侧表面进行冠状动脉搭桥术的再次手术患者。5例患者均有顽固性心绞痛，侧壁自身血管造影显示闭塞或既往静脉桥血管闭塞，且运动试验均为阳性。5例中有4例左乳内动脉至前降支通畅。患者仰卧位，取大隐静脉，分离股动脉和股静脉后，于左第五肋间行胸廓切开术，患者肝素化并行体外循环插管，打开心包，游离心脏，然后将左乳内动脉从左胸壁分离，或使用大隐静脉桥血管绕过相应病变。近端血流取自降主动脉，通过心包后壁为静脉桥血管制作隧道。所有患者术后恢复良好。对于有记录显示下外侧心肌缺血是症状主要原因且存在不利于前入路的缓解因素的患者，推荐采用该技术进行再次手术。
