Robinson M C, Thielmeier K A, Hill B B
Division of Cardiothoracic Surgery, University of Kentucky and Veterans Affairs Hospital, Lexington 40536, USA.
Ann Thorac Surg. 1997 Jun;63(6 Suppl):S30-4. doi: 10.1016/s0003-4975(97)00431-1.
The emergence of minimally invasive coronary artery bypass grafting and recent off-pump open sternotomy clinical reports have refocused attention on the technical aspects and outcome of grafting on the beating heart.
To optimize the surgical field we report a method using adenosine for induction of controlled intervals of ventricular asystole to produce a transiently still cardiac field that facilitates anastomotic accuracy.
Adenosine was used in 57 patients, 31 included off-pump coronary artery bypass grafting (27 by minimally invasive technique, 4 by open sternotomy). In a further 26 patients adenosine pauses were used for suture placement to control anastomotic bleeding after cardiopulmonary bypass. Average adenosine boluses per anastomosis were 9 (6-14), mean dose of adenosine per bolus (mg/kg) was 0.24 (0.15-0.35), mean duration of pause (seconds) was 6 (3-19), and mean time for arterial blood pressure (mean) to return to baseline (seconds) was 35 (13-48). Presence of repolarization arrhythmias was noted in 1 patient. There were no deaths. Two patients had recurrent myocardial ischemia shown on angiography to be the result of technical problems.
This report describes our experience with the emerging procedure of minimally invasive coronary operations and off-pump grafting with the adenosine technique. The method also includes mechanical devices and other pharmacological therapy to optimize the surgical field, and the technique has now become a standard component of our off-pump revascularization methods.
微创冠状动脉搭桥术的出现以及近期非体外循环下开胸手术的临床报告，重新将人们的注意力集中在心脏不停跳下搭桥手术的技术环节和手术效果上。
为优化手术视野，我们报告一种使用腺苷诱导可控性心室停搏间期的方法，以产生短暂静止的心脏视野，便于提高吻合的准确性。
57例患者使用了腺苷，其中31例为非体外循环冠状动脉搭桥术（27例采用微创技术，4例采用开胸手术）。另外26例患者在体外循环后使用腺苷暂停来控制吻合口出血。每个吻合口平均腺苷推注量为9次（6 - 14次），每次推注腺苷的平均剂量（mg/kg）为0.24（0.15 - 0.35），平均暂停时间（秒）为6秒（3 - 19秒），动脉血压（平均）恢复至基线的平均时间（秒）为35秒（13 - 48秒）。1例患者出现复极心律失常。无死亡病例。2例患者血管造影显示复发性心肌缺血是技术问题所致。
本报告描述了我们在微创冠状动脉手术和非体外循环搭桥手术中应用腺苷技术的经验。该方法还包括机械装置和其他药物治疗以优化手术视野，并且该技术现已成为我们非体外循环血运重建方法的标准组成部分。
