Schwartz D S, Ribakove G H, Grossi E A, Stevens J H, Siegel L C, St Goar F G, Peters W S, McLoughlin D, Baumann F G, Colvin S B, Galloway A C
Department of Surgery, Division of Cardiothoracic Surgery, New York University Medical Center, NY 10016, USA.
J Thorac Cardiovasc Surg. 1996 Mar;111(3):556-66. doi: 10.1016/s0022-5223(96)70307-0.
Thoracoscopic cardiac surgery is presently under intense investigation. This study examined the feasibility and efficacy of closed chest cardiopulmonary bypass and cardioplegic arrest in comparison with standard open chest methods in a dog model. The minimally invasive closed chest group (n = 6) underwent percutaneous cardiopulmonary bypass and cardiac venting, as well as antegrade cardioplegic arrest through use of a specially designed percutaneous endovascular aortic occluder and cardioplegic solution delivery system. The control group (n = 6) underwent standard sternotomy and conventional open chest cardiopulmonary bypass, aortic crossclamping, and antegrade cardioplegia. Ischemic arrest time was 1 hour in each group. Ventricular pressures and sonomicrometer segment lengths were recorded before bypass and at 30 and 60 minutes after bypass. Left ventricular function did not differ significantly between the two groups, as demonstrated by measurements of elastance and end-diastolic stroke work. Also, the preload recruitable work area was 69% and 60% of baseline at 30 and 60 minutes after bypass in the minimally invasive group versus 65% and 62% in the conventional control group (p = not significant); the stroke work end-diastolic length relationship was 78% and 71% of baseline in the minimally invasive group at these intervals versus 77% and 74% in the conventional control group (p = not significant). Myocardial temperatures were similar throughout bypass in the two groups, and ultrastructural examination of prebypass and postbypass biopsy specimens showed no differences between groups. These results demonstrate that minimally invasive cardiopulmonary bypass with cardioplegic arrest is as feasible, safe, and effective as conventional open chest cardiopulmonary bypass. Thus current technology may allow wider clinical application of closed chest cardiac surgery.
目前，胸腔镜心脏手术正在进行深入研究。本研究在犬模型中，将闭式胸廓心肺转流和心脏停搏的可行性及有效性与标准开胸方法进行了比较。微创闭式胸廓组（n = 6）采用经皮心肺转流和心脏排气，以及通过使用专门设计的经皮血管内主动脉封堵器和心脏停搏液输送系统进行顺行性心脏停搏。对照组（n = 6）采用标准胸骨切开术和传统的开胸心肺转流、主动脉交叉钳夹和顺行性心脏停搏。每组的缺血性停搏时间均为1小时。在转流前以及转流后30分钟和60分钟记录心室压力和声纳测量仪节段长度。通过弹性和舒张末期搏功测量表明，两组之间左心室功能无显著差异。此外，微创组在转流后30分钟和60分钟时可募集的前负荷工作面积分别为基线的69%和60%，而传统对照组为65%和62%（p = 无显著性差异）；在这些时间点，微创组的搏功舒张末期长度关系为基线的78%和71%，传统对照组为77%和74%（p = 无显著性差异）。两组在整个转流过程中心肌温度相似，转流前和转流后活检标本的超微结构检查显示两组之间无差异。这些结果表明，微创心肺转流联合心脏停搏与传统开胸心肺转流一样可行、安全且有效。因此，当前技术可能会使闭式胸廓心脏手术得到更广泛的临床应用。
