Fishman R L, Harvey S C, Zellner J L, Pinosky M L, Handy J R
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston 29425-2207, USA.
South Med J. 1997 Oct;90(10):965-71. doi: 10.1097/00007611-199710000-00001.
The concept of minimal surgical trauma is revolutionizing many surgical subspecialties, including cardiac surgery. Coronary artery revascularization can now be accomplished either thoracoscopically or through a small thoracotomy, sternotomy, or epigastric incision, with or without cardiopulmonary bypass (CPB).
The current literature was reviewed with regard to patient selection criteria for coronary artery bypass grafting (CABG) without CPB, indications for minimally invasive direct coronary artery bypass (MIDCAB), surgical and anesthetic technique, and outcome.
The MIDCAB is largely used in cases of single or double vessel disease. The procedure is done either thoracoscopically or under direct vision through a small incision rather than standard sternotomy. In non-CPB cases, the heart is pharmacologically manipulated to create a quiet operative field. Patients may be extubated and become ambulatory shortly after surgery and be discharged within a few days.
The MIDCAB avoids median sternotomy and, in many cases, CPB. MIDCAB may prove to play a prominent role in management of coronary artery disease in the future.
微创外科手术的理念正在革新包括心脏外科在内的许多外科亚专业。冠状动脉血运重建现在可以通过胸腔镜或小切口开胸术、胸骨切开术或上腹部切口来完成，可使用或不使用体外循环（CPB）。
回顾了当前关于非体外循环冠状动脉旁路移植术（CABG）的患者选择标准、微创直接冠状动脉旁路移植术（MIDCAB）的适应证、手术及麻醉技术以及手术结果的文献。
MIDCAB主要用于单支或双支血管病变的病例。该手术可通过胸腔镜或经小切口直视下完成，而非标准的胸骨切开术。在非体外循环病例中，通过药物控制心脏以创造安静的手术视野。患者术后不久即可拔除气管插管并下床活动，数天内即可出院。
MIDCAB避免了正中胸骨切开术，并且在许多情况下避免了体外循环。MIDCAB可能在未来冠状动脉疾病的治疗中发挥重要作用。
