Antona C, Pompilio G, Lotto A A, Di Matteo S, Agrifoglio M, Biglioli P
Department of Cardiac Surgery, University of Milan, Centro Cardiologico 1I. Monzino', IRCCS, Milano, Italy.
Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S62-7. doi: 10.1016/s1010-7940(98)00107-9.
There is a growing interest in cardiac surgery towards minimally invasive approach to coronary bypass operations without cardiopulmonary bypass.
From March 1995 to March 1997, 41 patients underwent a single left internal mammary artery (LIMA) to the left anterior descending artery (LAD) coronary grafting without cardiopulmonary bypass through a small left anterior thoracotomy (MIDCABG). The mean age was 61.2+/-8.7 years (range 43-77 years), 28 patients. were male (68.2%) and the redo rate was 4.8% (2/41). In all patients the coronary artery disease involved the LAD, which was occluded in seven patients (17.1%). Thirty-eight patients (96.2%) selected for MIDCABG had a monovascular disease on LAD not suitable for percutaneous coronary angioplasty; two (4.8%) a bivascular disease, and one (2.4%) a trivascular disease. Skin incision was performed in the 4th anterior intercostal space from the left parasternal line for a 10.5 cm length on average. The LIMA harvesting was partially video-assisted by thoracoscopy.
The LAD temporary occlusion was achieved with two double 5/0 polypropilene round-LAD sutures. The mean LAD ischemic time was 22+/-8 min (range 4-35 min). No thoracotomy procedure was changed into a sternotomy approach. We had one (2.4%) perioperative AMI; two patients (4.8%) were reoperated for bleeding. All patients underwent a postoperative angiographic reinvestigation within 1 month after surgery. All anastomoses were perfectly patent but two (4.8%). One patient was reoperated via a sternotomy access recycling the LIMA graft, the other one underwent successful PTCA. All patients also underwent an early and mid-term (6 months after surgery) echo-Doppler study of the LIMA flow and patency. At follow-up, performed at a mean of 8.7 months (range 1-23) after discharge, all patients were alive; no one experienced recurrence of angina. All patients also performed a mid-term negative treadmill stress test.
MIDCABG is, in selected patients, reliable and safe, and offers encouraging early and mid-term clinical results.
心脏外科手术对不进行体外循环的微创冠状动脉搭桥手术的兴趣日益浓厚。
1995年3月至1997年3月，41例患者通过左前小切口（MIDCABG）在非体外循环下接受了单根左乳内动脉（LIMA）至左前降支动脉（LAD）的冠状动脉移植术。平均年龄为61.2±8.7岁（范围43 - 77岁），28例为男性（68.2%），再次手术率为4.8%（2/41）。所有患者的冠状动脉疾病均累及LAD，其中7例（17.1%）LAD闭塞。因LAD单支血管病变不适合经皮冠状动脉腔内血管成形术而选择MIDCABG的患者有38例（96.2%）；2例（4.8%）为双支血管病变，1例（2.4%）为三支血管病变。皮肤切口在左胸骨旁线第4肋间进行，平均长度为10.5 cm。LIMA的获取部分借助胸腔镜辅助。
用两根双股5/0聚丙烯缝线实现了LAD的临时阻断。LAD平均缺血时间为22±8分钟（范围4 - 35分钟）。没有开胸手术改为胸骨切开术式。我们有1例（2.4%）围手术期急性心肌梗死；2例（4.8%）因出血再次手术。所有患者在术后1个月内均接受了术后血管造影复查。所有吻合口均完美通畅，但有2例（4.8%）除外。1例患者通过胸骨切开术再次手术，重新使用LIMA移植物，另1例成功接受了经皮冠状动脉腔内血管成形术。所有患者还接受了早期和中期（术后6个月）的LIMA血流及通畅情况的超声多普勒检查。在出院后平均8.7个月（范围1 - 23个月）进行随访时，所有患者均存活；无人发生心绞痛复发。所有患者中期平板运动试验结果均为阴性。
对于特定患者，MIDCABG可靠且安全，并能提供令人鼓舞的早期和中期临床结果。
