Perrault L P, Menasché P, Bidouard J P, Jacquemin C, Villeneuve N, Vilaine J P, Vanhoutte P M
Cardiovascular Division, Institut de Recherches Servier, Suresnes, France.
Ann Thorac Surg. 1997 Mar;63(3):751-5. doi: 10.1016/s0003-4975(96)01118-6.
Minimally invasive coronary artery bypass grafting aims to achieve less patient discomfort and a more rapid return to active life. Most approaches have used maintenance of the beating heart and control of the target coronary vessel by different hemostatic devices. The purpose of this study was to assess the effects of commonly used coronary artery snares and of the occlusion of the coronary vessel necessary for minimally invasive coronary artery operations on coronary endothelial function.
Coronary artery bypass grafting with an internal mammary artery to left anterior descending artery anastomosis was performed in a porcine model with a 30-minute period of ischemia and a subsequent 30-minute period of reperfusion, using snares on either side of the anastomotic site to achieve hemostasis of the operative field. Endothelium-dependent relaxation to serotonin was studied in conventional organ chamber experiments with rings taken from the left anterior descending artery at the proximal snare site, the anastomotic site in the segment that underwent the ischemia-reperfusion cycle, the distal snare site, and at a control segment. Responses to potassium chloride and bradykinin were also compared.
There were no significant differences in endothelium-dependent relaxation values among the four sites studied.
These results confirm that snaring of the coronary artery for achieving hemostasis at the anastomotic site when performing coronary artery bypass grafting on the beating heart does not cause endothelial dysfunction.
微创冠状动脉旁路移植术旨在减少患者不适并使其更快恢复正常活动。大多数方法采用维持心脏跳动，并通过不同的止血装置控制目标冠状动脉血管。本研究的目的是评估常用冠状动脉圈套器以及微创冠状动脉手术中冠状动脉血管闭塞对冠状动脉内皮功能的影响。
在猪模型中进行乳内动脉至左前降支动脉吻合的冠状动脉旁路移植术，缺血30分钟，随后再灌注30分钟，在吻合部位两侧使用圈套器实现手术野止血。在传统器官腔室实验中，研究取自左前降支动脉近端圈套器部位、经历缺血-再灌注循环节段的吻合部位、远端圈套器部位以及对照节段的血管环对5-羟色胺的内皮依赖性舒张作用。还比较了对氯化钾和缓激肽的反应。
所研究的四个部位的内皮依赖性舒张值无显著差异。
这些结果证实，在跳动心脏上进行冠状动脉旁路移植术时，为在吻合部位实现止血而对冠状动脉进行圈套不会导致内皮功能障碍。
