Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan.
BMJ Case Rep. 2023 Nov 27;16(11):e256642. doi: 10.1136/bcr-2023-256642.
Surgical approaches of minimally invasive direct coronary artery bypass and left atrial appendage exclusion are different, and issues may arise in cases of concomitant surgery. Moreover, the safety of concomitant procedures has not been established. A man in his 80s with a history of stroke required minimally invasive coronary artery bypass grafting and left atrial appendage closure for the stenosis of the left anterior descending artery and atrial fibrillation. He suffered from bladder bleeding, which required early reduction of anticoagulant and antiplatelet medication. Therefore, he wished for surgical treatment. A lateral incision was necessary for left atrial appendage closure in minimally invasive surgery. We performed totally endoscopic harvest of the internal thoracic artery without a robotic system. This method allowed the incision to be made more laterally. Combining the endoscopic harvest of the internal mammary artery with left atrial appendage closure via lateral incision may be a reasonable technique.
微创直接冠状动脉旁路和左心耳排除的手术入路不同，在同时进行手术的情况下可能会出现问题。此外，同时进行手术的安全性尚未确定。一位 80 多岁的男性，有中风病史，需要进行微创冠状动脉旁路移植术和左心耳闭合术，以治疗左前降支狭窄和心房颤动。他出现了膀胱出血，需要早期减少抗凝和抗血小板药物。因此，他希望进行手术治疗。微创外科中需要进行左心耳闭合的侧切口。我们在没有机器人系统的情况下进行了全内窥镜下内乳动脉采集。这种方法可以使切口更偏向外侧。将内窥镜下的内乳动脉采集与通过侧切口进行左心耳闭合相结合可能是一种合理的技术。
