Calafiore A M, Teodori G, Di Giammarco G, Vitolla G, Contini M
Department of Cardiac Surgery, G. D'Annunzio Chieti University, Italy.
Semin Thorac Cardiovasc Surg. 1997 Oct;9(4):305-11.
Left anterior descending grafting with a left internal thoracic artery on a beating heart via a small left anterior thoracotomy is a procedure that is becoming popular, even if not yet standardized. From November 21, 1994 through February 20, 1997, 411 patients underwent a small left anterior thoracotomy; 206 had single-vessel disease, 205 had multiple-vessel disease. The early mortality rate was 1.0% (4 patients); causes of death were cardiac, not operation-related in 3, and non-cardiac in 1. The late mortality rate was 1.4% (6 patients); causes of death were cardiac operation-related in 1, non-cardiac in 3. All patients had a postoperative Doppler-flow velocity assessment; 231 (56.2%) underwent an angiographic control during the first postoperative year. Some patients were selected, as every patient with conduit or anastomotic malfunction underwent angiography. The patency rate was 92.4% (214/231); perfect distal anastomoses were obtained in 87.0% (201/231). With increasing experience and new instruments for left internal thoracic artery harvesting and left anterior descending artery stabilization, from April 21, 1996, patency rate increased to 98.2% (107/109) and perfect patency rate to 95.4% (104/109); results are therefore improving with time. The left anterior small thoracotomy procedure gives acceptable midterm results and is a reasonable alternative to the median sternotomy when the left anterior descending artery needs to be grafted with the left internal thoracic artery.
经左前小切口在跳动心脏上用左乳内动脉进行左前降支移植术是一种日益流行的手术，即便尚未标准化。从1994年11月21日至1997年2月20日，411例患者接受了左前小切口手术；206例为单支血管病变，205例为多支血管病变。早期死亡率为1.0%（4例患者）；死亡原因中心脏相关但与手术无关的有3例，非心脏相关的有1例。晚期死亡率为1.4%（6例患者）；死亡原因中心脏手术相关的有1例，非心脏相关的有3例。所有患者术后均进行了多普勒血流速度评估；231例（56.2%）在术后第一年接受了血管造影检查。一些患者被选做此项检查，因为每例有血管桥或吻合口功能障碍的患者均接受了血管造影。通畅率为92.4%（214/231）；87.0%（201/231）获得了完美的远端吻合。随着经验的增加以及用于获取左乳内动脉和稳定左前降支动脉的新器械的出现，从1996年4月21日起，通畅率提高到了98.2%（107/109），完美通畅率提高到了95.4%（104/109）；因此，结果随时间推移而改善。左前小切口手术可给出可接受的中期结果，并且当需要用左乳内动脉移植左前降支动脉时，是胸骨正中切开术的合理替代方案。
