Borst C, Jansen E W, Tulleken C A, Gründeman P F, Mansvelt Beck H J, van Dongen J W, Hodde K C, Bredée J J
Departments of Cardiology and Cardiopulmonary Surgery, Heart Lung Institute, Utrecht University Hospital, The Netherlands.
J Am Coll Cardiol. 1996 May;27(6):1356-64. doi: 10.1016/0735-1097(96)00039-3.
This study assessed the feasibility of coronary artery bypass grafting on the beating heart without interruption of native coronary blood flow using a novel anastomosis site restraining device.
Recently, an end-to-side bypass technique was described that does not require interruption of flow in the recipient artery.
By means of a suction device ("Octopus"), in 31 pigs the epicardium was grasped and immobilized through an arm contraption fixed to the operating table. In the first 15 consecutive pigs (study I), the two-dimensional motion of an epicardial beacon was monitored. In 16 subsequent pigs (study II), an internal mammary artery was grafted under the microscope in two steps to a proximal coronary artery segment, without cardiopulmonary bypass. First, the internal mammary artery was sutured end-to-side to the outside of the coronary artery. Secondly, an orifice was punched in the partitioning coronary wall by an excimer laser catheter introduced through a temporary side-branch of the internal mammary artery.
Study II: During 43 suction periods in four anastomosis areas, immobilization was achieved for 15 to 169 min (>30 h in total) in 13 open- and 9 closed-chest procedures without hemodynamic deterioration. The area circumscribed by the edges of the beacon trajectory (area in which the anastomosis is to be tracked) was reduced from 73.0 +/- 43.0 mm(2) (mean +/- SD) to 1.3 +/- 0.5 mm(2) (p<0.001) in the open-chest and to 0.2 +/- 0.2 mm(2) in the closed-chest procedure. At 6 weeks, no myocardial or coronary suction lesions were found. Study II: Nonocclusive anastomosis surgery required 25 +/- 3 min. No leakage, serious arrhythmias, graft closure or hemodynamic deterioration occurred during the procedure or for 2 h after ligating the coronary artery proximally. At 6 weeks, all seven grafts were patent.
Coronary bypass on the beating heart without interruption of coronary flow is feasible. In both open- and in closed-chest procedures, the "Octopus" reduced anastomosis site motion to about 1 X 1 mm without adverse consequences.
本研究使用一种新型吻合部位限制装置，评估在不中断冠状动脉血流的情况下进行心脏不停跳冠状动脉搭桥术的可行性。
最近，描述了一种端侧旁路技术，该技术不需要中断受体动脉的血流。
借助一种抽吸装置（“章鱼”），在31头猪中，通过固定在手术台上的臂部装置抓住并固定心包。在连续的前15头猪（研究I）中，监测心包信标的二维运动。在随后的16头猪（研究II）中，在显微镜下分两步将胸廓内动脉移植到近端冠状动脉段，无需体外循环。首先，将胸廓内动脉端侧缝合到冠状动脉外侧。其次，通过经胸廓内动脉临时侧支引入的准分子激光导管在分隔冠状动脉壁上打孔。
研究II：在四个吻合区域的43次抽吸期间，在13例开胸和9例闭胸手术中，实现了15至169分钟（总计>30小时）的固定，且无血流动力学恶化。在开胸手术中，信标轨迹边缘所包围的区域（即跟踪吻合的区域）从73.0±43.0平方毫米（平均值±标准差）减少到1.3±0.5平方毫米（p<0.001），在闭胸手术中减少到0.2±0.2平方毫米。在6周时，未发现心肌或冠状动脉抽吸损伤。研究II：非闭塞性吻合手术需要25±3分钟。在手术过程中或近端结扎冠状动脉后2小时内，未发生渗漏、严重心律失常、移植物闭塞或血流动力学恶化。在6周时，所有7条移植物均通畅。
在不中断冠状动脉血流的情况下进行心脏不停跳冠状动脉搭桥术是可行的。在开胸和闭胸手术中，“章鱼”装置都将吻合部位的运动减少到约1×1毫米，且无不良后果。
