Lazzara R R, McLellan B A, Kidwell F E, Combs D T, Hanlon J T, Young E K
Division of Cardiac Services, St. Charles Medical Center, Bend, Oregon, USA.
Ann Thorac Surg. 1997 Dec;64(6):1725-7. doi: 10.1016/s0003-4975(97)00995-8.
The technical demands of beating heart operations raise concerns about anastomotic patency. This feasibility study tested the usefulness of intraoperative angiography during minimally invasive direct coronary artery bypass grafting (MIDCABG).
Ten patients underwent intraoperative angiography of the internal thoracic artery (ITA) after MIDCABG. Minimally invasive direct coronary artery bypass grafting was performed on a beating heart through the fourth or fifth intercostal space. Angiography was performed through the right or left femoral artery with a 7F introducer system placed before the operation. Views were obtained in the right and left anterior oblique and straight anterior projections.
There were no deaths or intraoperative morbidities related to MIDCABG or angiography. Seven patients demonstrated widely patent MIDCABG anastomoses with obliteration of all intercostals, widely patent ITA pedicles, good distal runoff, and placement of the ITA into the proper native coronary artery. Two patients had revisions of their ITA pedicles, which on repeated angiography showed correction. One patient's procedure was converted to a sternotomy because of poor distal runoff and haziness at the level of the MIDCABG anastomosis.
This feasibility study demonstrates the utility of intraoperative ITA angiography in identifying problems after MIDCABG. Intraoperative angiography may facilitate MIDCABG by documenting proper placement of conduits, obliteration of intercostal vessels, and patency of the MIDCABG anastomosis and ITA pedicle.
心脏不停跳手术的技术要求引发了人们对吻合口通畅性的担忧。本可行性研究测试了术中血管造影在微创直接冠状动脉旁路移植术（MIDCABG）中的作用。
10例患者在MIDCABG术后接受了胸廓内动脉（ITA）的术中血管造影。通过第四或第五肋间间隙在心脏不停跳的情况下进行微创直接冠状动脉旁路移植术。术前通过右或左股动脉放置7F导入系统进行血管造影。在右前斜位、左前斜位和直位前位获取图像。
没有与MIDCABG或血管造影相关的死亡或术中并发症。7例患者显示MIDCABG吻合口广泛通畅，所有肋间血管闭塞，ITA蒂广泛通畅，远端血流良好，且ITA被正确植入原生冠状动脉。2例患者对其ITA蒂进行了修正，再次血管造影显示已纠正。1例患者因远端血流不佳和MIDCABG吻合口处模糊而转为胸骨切开术。
这项可行性研究证明了术中ITA血管造影在识别MIDCABG术后问题方面的作用。术中血管造影可通过记录移植物的正确植入、肋间血管的闭塞以及MIDCABG吻合口和ITA蒂的通畅情况来促进MIDCABG手术。
