Bonatti Johannes, Wallner Stephanie, Crailsheim Ingo, Grabenwöger Martin, Winkler Bernhard
Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria.
Medical Faculty, Sigmund Freud University, Vienna, Austria.
J Thorac Dis. 2021 Mar;13(3):1922-1944. doi: 10.21037/jtd-20-1535.
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
20世纪90年代中期，心脏外科开始探索冠状动脉旁路移植术（CABG）的微创方法，并在25年的时间里开发出了高度差异化且创伤较小的手术方式。不再采用传统的胸骨切开术，而是在胸部做小切口或置入端口，采用心脏不停跳手术，有先进的远程体外循环系统以及视频设备可供使用，机器人技术实现了完全内镜手术入路。这篇综述描述了这些方法，报告了这些手术的术中及术后累积结果，并对微创冠状动脉旁路移植术所能达到的效果给出了综合观点。对1996年至2019年间发表的74个关于该主题的患者系列进行了综述。6种主要的微创和机器人辅助CABG术式应用于11135例患者。平均植入1.3±0.6支移植物，手术时间为3小时42分钟±1小时15分钟。手术的医院死亡率为1.0%，卒中率为0.6%。出血的翻修率为2.5%，肾衰竭率为0.9%。伤口感染发生率为1.2%，术后住院时间为5.6±2.2天。可以得出结论，微创和机器人辅助的冠状动脉旁路移植术在手术创伤显著降低的同时，具有足够的安全水平。
