Cooley D A
Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77030, USA.
Tex Heart Inst J. 1996;23(2):81-4.
A technique of limited access, direct vision surgery for performing coronary artery bypass grafting with the internal mammary artery is presented in this preliminary report. The procedure is performed without cardiopulmonary bypass. To gain access to the left (or right) coronary artery and the mammary artery, segments of the 3rd and 4th costal cartilages are removed. Before the pericardium is opened, the mammary artery is dissected distally under the 5th costal cartilage and proximally under the 3rd costal cartilage to the level of the 2nd costal cartilage. If the left anterior descending coronary artery is suitable for bypass, it is dissected and the bypass graft is placed. Limited access coronary bypass has been completed successfully in 8 of our first 9 patients. All 9 patients have had relief of anginal pain. This experience proves that coronary bypass operations can be performed in selected lesions without a quiet, bloodless field, thus avoiding the potential complications of cardiopulmonary bypass.
本初步报告介绍了一种采用有限切口、直视下用乳内动脉进行冠状动脉旁路移植术的技术。该手术无需体外循环。为暴露左（或右）冠状动脉及乳内动脉，需切除第3、4肋软骨段。在打开心包之前，先在第5肋软骨下方将乳内动脉向远端游离，在第3肋软骨下方将其向近端游离至第2肋软骨水平。若左前降支冠状动脉适合搭桥，则对其进行游离并置入搭桥移植物。在我们的前9例患者中，有8例成功完成了有限切口冠状动脉搭桥术。所有9例患者的心绞痛均得到缓解。这一经验证明，对于某些特定病变，可在无安静、无血手术视野的情况下进行冠状动脉搭桥手术，从而避免体外循环的潜在并发症。
