Sutlić Z, Kolovrat M, Biocina B, Rudez I, Zelić M, Nikić N
Department of Cardiac Surgery, Dubrava University Hospital, Zagreb, Croatia.
Acta Med Croatica. 1998;52(3):181-5.
Minimally invasive coronary artery surgery (MICS) has been defined as proceeding myocardial revascularization without cardiopulmonary bypass. Between January 1996 and August 1997, 19 patients (18 males, 1 female), aged 47-67 years (mean age 57.2 +/- 5.1 years), were operated on. All patients had single vessel coronary disease. In 11 (57.9%) patients, the operation was performed through median sternotomy, in 5 (26.3%) through left anterior small thoracotomy (the LAST procedure). In two (10.5%) patients, the operation began as a LAST, but conversion to median sternotomy was required due to lateroposition of the left anterior descending artery (LAD). In one (5.3%) patient, a minimal procedure was converted in to conventional cardiosurgical procedure with thrombendarterectomy and anastomosis of the left internal mammary artery (LIMA) to LAD. Anastomosis of LIMA to LAD was performed in 9 (47.4%) cases and of right internal mammary artery (RIMA) to right coronary artery (RCA) in four (21.1%) cases. In two (10.5%) cases, saphenous vein was used as a graft to RCA, and in four (21.1%) cases, to LAD. One (5.3%) patient died on the fourth postoperative day. One patient developed perioperative myocardial infarction, and one patient was reoperated on due to postoperative bleeding. Permanent pacemaker was implanted in one (5.3%) patient because of slow atrial fibrillation. The ischemic time was 8 to 25 minutes, and the whole procedure was completed in 90-175 minutes. Intensive care unit stay was up to 18 hours in 12 (63.2%) patients. The whole duration of hospitalization took from 7 to 14 days (mean 10.6 +/- 2.4 days). Minimally invasive coronary surgery is a safe and effective method in the surgical treatment of one-vessel coronary artery disease.
微创冠状动脉手术（MICS）被定义为在不进行体外循环的情况下进行心肌血运重建。1996年1月至1997年8月期间，对19例患者（18例男性，1例女性）进行了手术，年龄在47 - 67岁之间（平均年龄57.2±5.1岁）。所有患者均为单支冠状动脉疾病。11例（57.9%）患者通过正中胸骨切开术进行手术，5例（26.3%）通过左前小切口开胸术（LAST手术）进行。2例（10.5%）患者手术开始时采用LAST手术，但由于左前降支动脉（LAD）位置异常而转为正中胸骨切开术。1例（5.3%）患者，一个微创操作转为了带有动脉内膜血栓切除术以及左乳内动脉（LIMA）与LAD吻合的传统心脏手术操作。9例（47.4%）病例进行了LIMA与LAD吻合，4例（21.1%）病例进行了右乳内动脉（RIMA）与右冠状动脉（RCA）吻合。2例（10.5%）病例中，大隐静脉被用作RCA的移植物，4例（21.1%）病例中，被用作LAD的移植物。1例（5.3%）患者在术后第4天死亡。1例患者发生围手术期心肌梗死，1例患者因术后出血再次手术。1例（5.3%）患者因缓慢型心房颤动植入了永久性起搏器。缺血时间为8至25分钟，整个手术过程在90 - 175分钟内完成。12例（63.2%）患者在重症监护病房停留长达18小时。住院总时长为7至14天（平均10.6±2.4天）。微创冠状动脉手术是治疗单支冠状动脉疾病的一种安全有效的方法。
