Boonstra P W, Grandjean J G, Mariani M A
Thoraxcenter, University Hospital of Groningen, The Netherlands.
Ann Thorac Surg. 1997 Feb;63(2):405-7. doi: 10.1016/s0003-4975(96)00896-x.
The danger of coronary reoperations is mainly hidden in the reopening of the sternum and in the manipulation of the heart and the old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations if only the left anterior descending coronary artery needs to be revascularized and the left internal mammary artery has not been used previously.
From January 1995 until May 1996 we performed 81 minimally invasive direct coronary artery bypass procedures through a small anterolateral thoracotomy in the fifth intercostal space, anastomosing the left internal mammary artery to the left anterior descending coronary artery. Six of these 81 were reoperative minimally invasive direct coronary artery bypass procedures on patients who had previously undergone coronary grafting through a median sternotomy with a vein graft to the left anterior descending coronary artery.
Mean operation time was 85.8 +/- 22.2 minutes. Mean length of the mammary pedicles was 13 +/- 2 cm. Mean coronary occlusion time was 9.2 +/- 3.2 minutes. Mean postoperative hospital stay was 5.7 +/- 1.2 days (range, 5 to 8 days). No mortality and no cardiac-related morbidity were recorded.
These results suggest that the technique is safe and promising in selected cases of reoperative coronary operation.
再次冠状动脉手术的风险主要在于胸骨的重新打开以及心脏和旧移植血管的操作。因此，如果仅需对左前降支冠状动脉进行血运重建且之前未使用过左乳内动脉，那么微创直接冠状动脉旁路移植术似乎是再次冠状动脉手术的理想技术。
从1995年1月至1996年5月，我们通过第五肋间小前外侧开胸切口进行了81例微创直接冠状动脉旁路移植术，将左乳内动脉与左前降支冠状动脉吻合。这81例中有6例是对先前通过正中开胸将静脉移植至左前降支冠状动脉进行冠状动脉移植的患者进行的再次手术微创直接冠状动脉旁路移植术。
平均手术时间为85.8±22.2分钟。乳内动脉蒂平均长度为13±2厘米。平均冠状动脉阻断时间为9.2±3.2分钟。术后平均住院时间为5.7±1.2天（范围为5至8天）。无死亡病例，也未记录到与心脏相关的并发症。
这些结果表明，该技术在特定的再次冠状动脉手术病例中是安全且有前景的。
