Voutilainen S, Verkkala K, Järvinen A, Kaarne M, Keto P, Voutilainen P, Mattila S
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Ann Thorac Surg. 1998 Feb;65(2):444-8. doi: 10.1016/s0003-4975(97)01129-6.
Anastomosis of the left internal thoracic artery to the left anterior descending artery without sternotomy and without cardiopulmonary bypass is a standard approach in minimally invasive coronary artery bypass grafting. To expand the indications for minimally invasive coronary artery bypass grafting from one-vessel disease to two-vessel disease, we began to perform anastomosis of the right gastroepiploic artery (RGEA) to the right coronary artery (RCA).
From February to November 1996, an RGEA graft was used in 25 of the 100 patients who underwent minimally invasive coronary artery bypass grafting at our clinic. Eleven of the patients had only RCA disease and 14 had both RCA and left anterior descending artery disease. One of the operations was a redo coronary artery bypass grafting. The RGEA was anastomosed to the RCA through a laparotomy incision and the left internal thoracic artery was anastomosed to the left anterior descending artery through a left anterior thoracotomy. In 5 patients, the RGEA was lengthened by venous grafting.
All patients underwent angiography after operation; 82.6% of the RGEA grafts and all the left internal thoracic artery grafts were functioning well. In three of the four nonvisualized RGEA grafts, the percentage of proximal stenosis of the RCA seen on postoperative angiography was not critical (40%, 50%, and 50%, respectively), allowing significant competitive flow through the native bypassed RCA. The patency of all the RGEA grafts without competitive flow was 95%, with a 95% confidence interval of 75.1% to 99.9%.
The indications for minimally invasive coronary artery bypass grafting could be extended to primary operations in patients with left anterior descending artery and RCA lesions by using both the left internal thoracic artery and the RGEA.
在非开胸且非体外循环的情况下，将左胸廓内动脉与左前降支动脉进行吻合是微创冠状动脉搭桥术的标准术式。为了将微创冠状动脉搭桥术的适应证从单支血管病变扩展至双支血管病变，我们开始进行右胃网膜动脉（RGEA）与右冠状动脉（RCA）的吻合。
1996年2月至11月，在我们诊所接受微创冠状动脉搭桥术的100例患者中，25例使用了RGEA移植物。其中11例患者仅患有RCA疾病，14例同时患有RCA和左前降支动脉疾病。1例手术为再次冠状动脉搭桥术。通过剖腹手术切口将RGEA与RCA进行吻合，通过左前外侧开胸术将左胸廓内动脉与左前降支动脉进行吻合。5例患者通过静脉移植延长了RGEA。
所有患者术后均进行了血管造影；82.6%的RGEA移植物和所有左胸廓内动脉移植物功能良好。在4例未显影的RGEA移植物中的3例中，术后血管造影显示RCA近端狭窄百分比不严重（分别为40%、50%和50%），允许有大量竞争性血流通过未搭桥的自身RCA。所有无竞争性血流的RGEA移植物通畅率为95%，95%置信区间为75.1%至99.9%。
通过使用左胸廓内动脉和RGEA，微创冠状动脉搭桥术的适应证可扩展至患有左前降支动脉和RCA病变的患者的初次手术。
