Nishiwaki N, Kaneda K, Kondo T
Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital, Japan.
Kyobu Geka. 1998 Apr;51(4):277-82.
From Jan. to Oct. in 1997, we performed 18 minimally invasive direct coronary artery bypass (MIDCAB), aged from 45 to 86 years (the mean age of 69 years). They had single LAD disease post PTCA failure in 2 patients, and multiple vessel disease in 16 patients including left main stenosis in 2 patients. Sixteen patients had associated risk factors for using cardiopulmonary bypass, such as cerebrovascular disease in 9 patients, calcification of ascending aorta in 5 patients, renal failure in 2 patients, old age over 80 years in 4 patients and cancer in one patient. Single bypass grafting of left internal thoracic artery (LITA) to left anterior descending artery (LAD) underwent through left anterior small thoracotomy in 9 patients, double bypass grafting of gastroepiploic artery or right ITA to right coronary artery with LITA to LAD in 9 patients through subxiphoid small incision or right anterior small thoracotomy. The mean number of distal anastomosis was 1.5/patient. All patients are alive and asymptomatic, and postoperative angiography demonstrated the patency rate of 96.2% (26/27). MIDCAB is considered as a justified and safe technique for the patients who are ineligible for standard coronary artery bypass grafting.
1997年1月至10月，我们实施了18例微创直接冠状动脉旁路移植术（MIDCAB），患者年龄在45至86岁之间（平均年龄69岁）。其中2例患者为单支左前降支病变且PTCA失败，16例患者为多支血管病变，包括2例左主干狭窄。16例患者存在使用体外循环的相关危险因素，如9例脑血管疾病、5例升主动脉钙化、2例肾衰竭、4例80岁以上高龄以及1例癌症患者。9例患者通过左前小切口将左胸廓内动脉（LITA）单旁路移植至左前降支（LAD），9例患者通过剑突下小切口或右前小切口将胃网膜动脉或右胸廓内动脉双旁路移植至右冠状动脉，同时将LITA移植至LAD。每位患者远端吻合的平均数量为1.5个。所有患者均存活且无症状，术后血管造影显示通畅率为96.2%（26/27）。对于不适合标准冠状动脉旁路移植术的患者，MIDCAB被认为是一种合理且安全的技术。
