Bonatti J, Ladurner R, Hangler H, Katzgraber F
University Clinic of Surgery/Cardiac Surgery Innsbruck, Austria.
Eur J Cardiothorac Surg. 1998 Oct;14 Suppl 1:S71-5. doi: 10.1016/s1010-7940(98)00109-2.
Minimally invasive multiple vessel revascularization has been accomplished using all arterial graft concepts and aortocoronary vein grafts. The aim of the present study was to determine the technical feasibility of minimally invasive axillary artery to coronary artery vein grafting in the human cadaver.
In seven human cadavers the axillary artery was approached bilaterally via a small incision above the anterior axillary fold. The left anterior descending coronary artery system and the right coronary artery system were exposed via a left anterior minithoracotomy and a subxiphoid incision respectively. Saphenous vein grafts were anastomosed end to side to the axillary artery and brought to the target vessels following a transpleural route. The vein grafts were then sutured to the left anterior descending artery and to the posterior descending artery through the mini-incisions.
Axillocoronary bypass grafting to the left anterior descending artery was performed successfully in seven cases, axillocoronary bypass grafting to the posterior descending artery was accomplished in six cases. The mean length of the mini-incisions was as follows: left axillary artery exposure 5.1+/-1.5 cm, right axillary artery exposure 5.5+/-2.0 cm, left anterior minithoracotomy 10.8+/-1.9 cm, subxiphoid incision 9.4+/-1.9 cm. The mean length of saphenous vein required for the left axillary artery to left anterior descending artery bypass was 18.9+/-2.8 cm, the mean length of vein required for the right axillary artery to posterior descending artery bypass was 26.0+/-2.6 cm. This was significantly longer than the aortocoronary route (ascending aorta to left anterior descending artery 12.5+/-2.2 cm P = 0.0001, ascending aorta to posterior descending artery 18.3+/-2.9 cm P < 0.0001).
From this study we conclude that minimally invasive axillocoronary venous bypass grafting to the left anterior descending artery system and to the distal right coronary artery system is technically feasible in the human cadaver.
利用所有动脉移植概念和主动脉冠状动脉静脉移植已完成微创多支血管血运重建。本研究的目的是确定在人体尸体中进行微创腋动脉至冠状动脉静脉移植的技术可行性。
在7具人体尸体中，通过腋前襞上方的小切口双侧暴露腋动脉。分别通过左前小切口和剑突下切口暴露左前降支冠状动脉系统和右冠状动脉系统。大隐静脉移植血管与腋动脉端侧吻合，并经胸膜腔途径引至目标血管。然后通过小切口将静脉移植血管缝合至左前降支动脉和后降支动脉。
7例成功进行了左前降支动脉的腋冠状动脉搭桥术，6例完成了后降支动脉的腋冠状动脉搭桥术。小切口的平均长度如下：左腋动脉暴露5.1±1.5cm，右腋动脉暴露5.5±2.0cm，左前小切口10.8±1.9cm，剑突下切口9.4±1.9cm。左腋动脉至左前降支动脉搭桥所需大隐静脉的平均长度为18.9±2.8cm，右腋动脉至后降支动脉搭桥所需静脉的平均长度为26.0±2.6cm。这明显长于主动脉冠状动脉途径（升主动脉至左前降支动脉12.5±2.2cm，P = 0.0001；升主动脉至后降支动脉18.3±2.9cm，P < 0.0001）。
从本研究我们得出结论，在人体尸体中，对左前降支动脉系统和右冠状动脉远端系统进行微创腋冠状动脉静脉搭桥术在技术上是可行的。
