Fann J I, Pompili M F, Stevens J H, Siegel L C, St Goar F G, Burdon T A, Reitz B A
Department of Cardiothoracic Surgery, Stanford University School of Medicine, California 94305, USA.
Ann Thorac Surg. 1997 Jun;63(6 Suppl):S35-9. doi: 10.1016/s0003-4975(97)00428-1.
A less invasive approach to cardiac surgery has been propelled by recent advances in video-assisted surgery. Previous obstacles to minimally invasive cardiac operations with cardioplegic arrest included limitations in operative exposure, inadequate perfusion technology, and inability to provide myocardial protection.
Port-access technology allows endovascular aortic occlusion, cardioplegia delivery, and left ventricular decompression. The endoaortic clamp is a triple-lumen catheter with an inflatable balloon at its distal end. Antegrade cardioplegia is delivered through a central lumen, which also acts as an aortic root vent, a second lumen is used as an aortic root pressure monitor, and a third lumen is used for balloon inflation to provide aortic occlusion.
Experimental and clinical studies have demonstrated the feasibility of port-access coronary artery bypass grafting and port-access mitral valve procedures. Endovascular cardiopulmonary bypass using the endoaortic clamp was effective in achieving cardiac arrest and myocardial protection to allow internal mammary artery to coronary artery anastomosis in a still and bloodless field. Intracardiac procedures, such as mitral valve replacement or repair, have been successfully performed clinically.
The port-access system effectively achieves cardiopulmonary bypass and cardioplegic arrest, thereby enabling the surgeon to perform cardiac procedures in a minimally invasive fashion. This system provides for endovascular aortic occlusion, cardioplegia delivery, and left ventricular decompression.
视频辅助手术的最新进展推动了心脏手术采用侵入性较小的方法。以往心脏停搏下行微创心脏手术的障碍包括手术视野受限、灌注技术不足以及无法提供心肌保护。
端口入路技术允许进行血管内主动脉阻断、心脏停搏液输注和左心室减压。主动脉内阻断钳是一种三腔导管，其远端有一个可充气的球囊。顺行心脏停搏液通过中央腔输注，该腔还作为主动脉根部排气孔，第二个腔用作主动脉根部压力监测器，第三个腔用于球囊充气以实现主动脉阻断。
实验和临床研究已证明端口入路冠状动脉搭桥术和端口入路二尖瓣手术的可行性。使用主动脉内阻断钳的血管内心肺转流在实现心脏停搏和心肌保护方面是有效的，从而能够在静止且无血的视野中进行乳内动脉至冠状动脉的吻合。心脏内手术，如二尖瓣置换或修复，已在临床上成功实施。
端口入路系统有效地实现了心肺转流和心脏停搏，从而使外科医生能够以微创方式进行心脏手术。该系统可进行血管内主动脉阻断、心脏停搏液输注和左心室减压。
