Gill I S, FitzGibbon G M, Higginson L A, Valji A, Keon W J
Department of Cardiothoracic Surgery, University of Ottawa Heart Institute, Ontario, Canada.
Ann Thorac Surg. 1997 Sep;64(3):710-4. doi: 10.1016/s0003-4975(97)00756-x.
Notwithstanding the advantages offered by minimally invasive coronary bypass, valid concerns have been raised about the technical accuracy of the distal anastomoses that can be fashioned on a beating heart. The main objective of our study was to undertake early and complete qualitative angiographic graft analysis in all patients undergoing this procedure.
All enrolled patients (25) from January to October 1996 who had bypass done by one surgeon via left minithoracotomy (19) or median sternotomy (6) on a beating heart underwent postoperative angiography within 4 to 6 hours. These angiograms were then reviewed for qualitative analysis and compared with a similar series done under conventional cardioplegic arrest.
There was 97.5% graft patency (28/29) and no anastomotic occlusions. One internal thoracic artery was damaged. There was no mortality and no perioperative myocardial infarctions. All patients are alive and symptom free. The follow-up is 100% complete and ranges from 15 days to 11 months. Of the 26 anastomoses that could be assessed, 21 (81%) were grade A and 5 (19%) were grade B. In comparison, 24/25 (96%) of the anastomoses fashioned on an arrested heart by the same surgeon were grade A (p = 0.175).
Minimally invasive coronary bypass can be carried out effectively and safely in a select group of patients, and the development of stabilizing devices and proper instrumentation should further improve results.
尽管微创冠状动脉搭桥术具有诸多优势，但对于在跳动心脏上进行的远端吻合术的技术准确性，人们也提出了合理的担忧。我们研究的主要目的是对所有接受该手术的患者进行早期且全面的血管造影移植物定性分析。
1996年1月至10月，所有入组患者（共25例），均由同一外科医生通过左前外侧小切口（19例）或正中胸骨切开术（6例）在跳动心脏上完成搭桥手术，并于术后4至6小时内接受血管造影。随后对这些血管造影进行定性分析，并与在传统心脏停搏下完成的类似系列手术进行比较。
移植物通畅率为97.5%（28/29），无吻合口闭塞。1例胸廓内动脉受损。无死亡病例，也无围手术期心肌梗死。所有患者均存活且无症状。随访率达100%，随访时间为15天至11个月。在可评估的26个吻合口中，21个（81%）为A级，5个（19%）为B级。相比之下，同一位外科医生在心脏停搏下进行的吻合口中，24/25（96%）为A级（p = 0.175）。
微创冠状动脉搭桥术在特定患者群体中能够有效且安全地实施，稳定装置和合适器械的发展应能进一步改善手术效果。
