Calafiore A M, Teodori G, Di Giammarco G, Vitolla G, Iaco' A, Iovino T, Cirmeni S, Bosco G, Scipioni G, Gallina S
Department of Cardiac Surgery, University G. D'Annunzio, Chieti, Italy.
Ann Thorac Surg. 1997 Jun;63(6 Suppl):S72-5. doi: 10.1016/s0003-4975(97)00426-8.
We reviewed our experience with left internal mammary artery (LIMA)-to-left anterior descending artery (LAD) anastomosis on a beating heart through a left anterior small thoracotomy.
This procedure was performed in 343 of 358 scheduled patients; in 15 (4.2%) the LAD was not suitable or was too small. The chest was opened in the fourth (127, 37.0%) or fifth (197, 57.4%) intercostal space, or both (19, 5.6%); the length of the harvested LIMA was 4-15 cm. The LAD was occluded by means of two 4-0 Prolene (Ethicon, Somerville, NJ) sutures, both snared on a small piece of silicone tubing. The anastomosis was performed with two 8-0 Prolene sutures. In the early postoperative period all patients underwent angiography or a doppler flow assessment of the LIMA or both.
In 310 patients the LIMA was connected directly to the LAD; to elongate the LIMA, in 30 patients an inferior epigastric artery and in 3 patients a saphenous vein was used. In 2 patients the diagonal branch was also grafted using an inferior epigastric artery from the LIMA. Three patients (0.9%) died during the first 30 days after the operation, and 4 other patients (1.2%) died after the first month. Twenty-five patients (7.3%) were reoperated on because of anastomotic or conduit failure, 18 (5.2%) early and 7 (2.1%) late; one additional patient had a late percutaneous transluminal coronary angioplasty for anastomotic stenosis. At a mean of 9.5 +/- 5.7 months of follow-up, 336 patients (98.0%) were alive, asymptomatic with or without medical treatment, and without cardiac events.
Left internal mammary artery-to-LAD anastomosis performed on a beating heart through a left anterior small thoracotomy is a procedure that can be performed with low risk and acceptable midterm results in selected patients.
我们回顾了通过左前小切口开胸在跳动心脏上进行左乳内动脉（LIMA）至左前降支动脉（LAD）吻合术的经验。
358例计划手术的患者中有343例接受了该手术；15例（4.2%）患者的LAD不适合或过细。在第四肋间（127例，37.0%）或第五肋间（197例，57.4%）或两者（19例，5.6%）开胸；获取的LIMA长度为4 - 15厘米。LAD通过两根4 - 0普理灵缝线（Ethicon公司，新泽西州萨默维尔）阻断，两根缝线均套在一小段硅胶管上。吻合术用两根8 - 0普理灵缝线进行。术后早期所有患者均接受了LIMA的血管造影或多普勒血流评估或两者。
310例患者中LIMA直接与LAD相连；为延长LIMA，30例患者使用了腹壁下动脉，3例患者使用了大隐静脉。2例患者还使用LIMA的腹壁下动脉移植了对角支。3例患者（0.9%）在术后30天内死亡，另外4例患者（1.2%）在第一个月后死亡。25例患者（7.3%）因吻合口或血管桥失败接受了再次手术，18例（5.2%）为早期，7例（2.1%）为晚期；另有1例患者因吻合口狭窄接受了晚期经皮腔内冠状动脉成形术。平均随访9.5±5.7个月时，336例患者（98.0%）存活，无论是否接受治疗均无症状，且无心脏事件发生。
通过左前小切口开胸在跳动心脏上进行LIMA至LAD吻合术是一种在特定患者中可低风险实施且中期结果可接受的手术。
