Uppal R, Mills N L, Wechsler A S, Smith P K
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Ann Thorac Surg. 1993 May;55(5):1275-6. doi: 10.1016/0003-4975(93)90059-q.
This paper describes our experience in performing saphenous vein bypass grafts to the circumflex coronary artery system with a left thoracotomy in 9 patients. Illustrative case reports demonstrate the spectrum of patients for whom this approach has been useful. The advantage of this technique is that it allows the surgeon to avoid the adhesions that make a redo sternotomy time-consuming and potentially dangerous when previously patent saphenous vein or internal mammary grafts are present. It is particularly useful for patients requiring grafting to the circumflex coronary artery system, especially if the patient is in relatively unstable condition and would benefit from rapid institution of cardiopulmonary bypass. The technique generally employs cannulation of the descending thoracic aorta for arterial inflow and of the main pulmonary artery for venous return. Usually the proximal end of the graft is easily placed to the left subclavian artery. Coronary anastomosis is performed on the cold (15 degrees C), fibrillating heart, and aortic cross-clamping and cardioplegic arrest have not been necessary. Venting is possible through the left atrial appendage should any rise in filling pressures occur. Saphenous vein or internal mammary artery may be used. All patients undergoing this technique have had expeditious discharge from the hospital and excellent relief of symptoms. The technique is an alternative to median sternotomy for properly selected patients.
本文描述了我们采用左胸廓切开术对9例患者进行大隐静脉至冠状动脉回旋支系统旁路移植术的经验。典型病例报告展示了该方法适用的患者范围。此技术的优点在于，当存在既往通畅的大隐静脉或乳内动脉移植物时，外科医生可避免因粘连而导致再次正中胸骨切开术耗时且具有潜在危险性。对于需要进行冠状动脉回旋支系统移植的患者，该技术尤为有用，特别是当患者处于相对不稳定状态且能从快速建立体外循环中获益时。该技术通常采用经胸降主动脉插管进行动脉血流灌注，经主肺动脉插管进行静脉回流。通常移植物近端易于吻合至左锁骨下动脉。冠状动脉吻合在心脏低温（15摄氏度）、颤动状态下进行，无需进行主动脉交叉阻断和心脏停搏。如有充盈压升高，可通过左心耳进行排气。可使用大隐静脉或乳内动脉。所有接受该技术治疗的患者均已迅速出院且症状得到显著缓解。对于经过适当选择的患者，该技术是正中胸骨切开术的一种替代方法。
