University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
J Thorac Cardiovasc Surg. 2021 Oct;162(4):1109-1119.e4. doi: 10.1016/j.jtcvs.2019.12.136. Epub 2020 Apr 8.
Multivessel minimally invasive coronary artery bypass grafting, performed chiefly with left internal thoracic artery and saphenous vein grafts through a left anterolateral thoracotomy, has recently emerged as an alternative to conventional coronary artery bypass grafting. The present study involves our initial experience with respect to early postoperative and angiographic outcomes after total arterial multivessel off-pump minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries.
A total of 88 consecutive patients undergoing total arterial off-pump minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries without ascending aortic manipulation were included in this study. Bilateral internal thoracic arteries were harvested under direct vision through a left anterolateral thoracotomy and used as Y or in situ grafts. Multivessel grafting was performed off pump. Postoperative graft assessment was performed in 51 patients.
The mean age of patients was 67.1 ± 7.2 years, and 79 patients (89.8%) were male. The mean body mass index and ejection fraction were 26.7 ± 2.7 kg/m and 57.6% ± 6.6%, respectively, and 40 patients (45.5%) had left main disease. No intraoperative conversions to cardiopulmonary bypass or sternotomy occurred. A total of 209 distal anastomoses (mean 2.4 ± 0.5) were performed, with 57 patients undergoing double, 29 patients undergoing triple, and 2 patients undergoing quadruple coronary artery bypass grafting. There was no in-hospital mortality, and 5 patients underwent reexploration for bleeding. No patient had stroke or chest wound infections. Predischarge coronary angiography revealed an overall graft patency rate of 96.8%.
Off-pump minimally invasive coronary artery bypass grafting using total arterial revascularization with bilateral internal thoracic arteries is a feasible and safe operation that is associated with excellent short-term outcomes and early graft patency. Future studies should focus on improving the generalizability and reproducibility of this technique.
多支微创冠状动脉旁路移植术，主要通过左前外侧开胸使用左内乳动脉和隐静脉移植物进行，最近已成为传统冠状动脉旁路移植术的替代方法。本研究涉及我们使用双侧内乳动脉进行全动脉非体外循环微创冠状动脉旁路移植术的早期术后和血管造影结果的初步经验。
本研究共纳入 88 例连续接受双侧内乳动脉全动脉非体外循环微创冠状动脉旁路移植术的患者，不进行升主动脉操作。双侧内乳动脉通过左前外侧开胸直视下采集，用作 Y 型或原位移植物。多支血管旁路移植术在非体外循环下进行。51 例患者进行了术后移植物评估。
患者的平均年龄为 67.1±7.2 岁，79 例（89.8%）为男性。平均体重指数和射血分数分别为 26.7±2.7kg/m 和 57.6%±6.6%，40 例（45.5%）患有左主干疾病。无术中转为体外循环或正中切开。共进行了 209 个远端吻合口（平均 2.4±0.5），57 例患者进行了双支，29 例患者进行了三支，2 例患者进行了四支冠状动脉旁路移植术。无院内死亡，5 例患者因出血行再次探查。无患者发生中风或胸部伤口感染。出院前的冠状动脉造影显示总体移植物通畅率为 96.8%。
使用双侧内乳动脉进行全动脉血运重建的非体外循环微创冠状动脉旁路移植术是一种可行且安全的手术，具有出色的短期结果和早期移植物通畅率。未来的研究应侧重于提高该技术的推广性和可重复性。
