Robinson M C, Gross D R, Thielmeier K A, Hill B B, Zeman W F
Division of Cardiovascular and Thoracic Surgery, College of Medicine, University of Kentucky, Lexington 40536-0084, USA.
Ann Thorac Surg. 1997 Jul;64(1):64-9. doi: 10.1016/s0003-4975(97)00128-8.
This porcine model was designed to develop a minimally invasive method for internal mammary artery (IMA) grafting using an anterior mediastinal approach and without routine use of cardiopulmonary bypass.
Assessment was made of IMA mobilization through a small parasternal incision, the feasibility of coronary artery grafting with cardiopulmonary bypass using this approach, and conditions for off-pump bypass grafting.
In group 1, 6 pigs underwent IMA mobilization through a 5-cm horizontal midparasternal incision. Of the 2 group 2 pigs, 1 underwent IMA grafting to the left anterior descending coronary artery and the other, bilateral IMA grafting to the left anterior descending and right coronary arteries using femoral-vessel cardiopulmonary bypass. In group 3, 4 of 10 pigs had successful off-pump grafting during retrograde regional coronary venous perfusion of arterial blood. Retrograde coronary venous perfusion could not be established in the other 6 pigs, and attempts at off-pump grafting failed.
The study demonstrates that coronary artery grafting with the IMA by this minimally invasive off-pump method is feasible, although it draws attention to areas of concern and potential methods of correction. The model provides a realistic and important learning platform for the surgical issues involved with this minimally invasive technique.
本猪模型旨在开发一种使用前纵隔入路且不常规使用体外循环的微创内乳动脉（IMA）移植方法。
评估通过小的胸骨旁切口游离IMA的情况、使用该入路进行体外循环冠状动脉移植的可行性以及非体外循环搭桥移植的条件。
在第1组中，6头猪通过5厘米的胸骨旁水平切口进行IMA游离。在第2组的2头猪中，1头将IMA移植到左前降支冠状动脉，另一头使用股血管体外循环将双侧IMA移植到左前降支和右冠状动脉。在第3组中，10头猪中有4头在逆行区域冠状动脉静脉灌注动脉血期间成功进行了非体外循环移植。其他6头猪无法建立逆行冠状动脉静脉灌注，非体外循环移植尝试失败。
该研究表明，通过这种微创非体外循环方法用IMA进行冠状动脉移植是可行的，尽管它提请注意需要关注的领域和潜在的纠正方法。该模型为与这种微创技术相关的手术问题提供了一个现实且重要的学习平台。
