Jatene F B, Fernandes P M, Stolf N A, Kalil R, Hayata A L, Assad R, Mady C, Hueb W, de Oliveira S A, Pileggi F, Jatene A D
Instituto do Coração do Hospital das Clínicas-FMUSP.
Arq Bras Cardiol. 1997 Feb;68(2):107-11.
In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation.
Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered.
All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke.
MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.
为了将冠状动脉旁路移植术（CABG）的主要益处与侵入性较小的手术相关联，微创冠状动脉旁路移植术（MICABG）已被采用。这项工作的目的是报告我们使用电视辅助胸腔镜手术（VATS）来辅助操作的这种技术方法的初步经验。
对26例患者进行了手术，其中19例男性，年龄在44至83岁之间，均患有前降支动脉孤立病变。在第四肋间间隙进行8 - 10厘米的左前小切口开胸手术。通过该切口放置VATS的光学装置以及手术器械，以便完成左乳内动脉（LIMA）的完整游离。未使用体外循环，通过静脉注射β受体阻滞剂降低心率。对于LIMA - 前降支动脉吻合，使用近端和远端止血带，并静脉注射1.5mg/kg肝素。
所有患者术后恢复情况均令人满意，大多数患者在术后72小时出院。有2例患者切口愈合延迟，25例患者无症状，术后平均随访4个月。1例患者在术后第二个月因中风死亡。
与传统手术相比，MICABG使手术成为可能，具有更好的美学效果、更低的成本，并能实现更快的恢复。通过开胸本身使用VATS，无需其他切口即可游离LIMA。与不使用VATS的小切口开胸手术相比，它还能更充分地游离LIMA。
