Suma H, Kigawa I, Horii T, Tanaka J, Fukuda S, Wanibuchi Y
Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Ann Thorac Surg. 1995 Oct;60(4):1063-6. doi: 10.1016/0003-4975(95)00489-8.
The left thoracotomy approach to avoid injury of the patent old graft and the myocardium with mid sternal reentry at coronary artery reoperation.
The left thoracotomy approach was used in 13 patients. There were 11 men and 2 women with a mean age of 63 years, ranging from 39 to 75 years. Three patients were having their third coronary bypass operation. In 11 patients, distal anastomoses were performed under circulatory arrest with moderate hypothermia. In the other 2 patients, distal anastomoses were performed on a beating heart. No aortic cross-clamp was applied in all patients. The mean number of distal anastomoses was 1.8; the grafted vessels were 11 anterior descending, 3 diagonal, 8 circumflex, and 1 posterolateral coronary arteries. Used grafts were 17 saphenous veins, 4 left internal thoracic arteries, and 2 gastroepiploic arteries. Inflow sites of the free graft were descending aorta in 10 patients and left subclavian artery in 3 patients.
All patients were alive and well at the mean follow-up of 16 months, and all grafts were patent.
The left thoracotomy approach is safe and effective for reoperation on the left coronary artery system, and circulatory arrest is convenient and safe for performing distal anastomosis.
在冠状动脉再次手术中采用左胸切口入路，以避免损伤已存在的陈旧性移植血管和心肌，并经胸骨正中再次进入。
13例患者采用左胸切口入路。其中男性11例，女性2例，平均年龄63岁，年龄范围为39至75岁。3例患者接受第三次冠状动脉搭桥手术。11例患者在中度低温循环阻断下进行远端吻合。另外2例患者在心脏跳动下进行远端吻合。所有患者均未应用主动脉交叉钳夹。远端吻合的平均数量为1.8；移植血管包括11支前降支、3支对角支、8支回旋支和1支后外侧冠状动脉。使用的移植血管包括17条大隐静脉、4条左内乳动脉和2条胃网膜动脉。游离移植血管的流入部位，10例为降主动脉，3例为左锁骨下动脉。
平均随访16个月时，所有患者均存活且情况良好，所有移植血管均通畅。
左胸切口入路对左冠状动脉系统再次手术安全有效，循环阻断便于且安全地进行远端吻合。
