Mueller X M, Tevaearai H T, Bosshard W, Vogt P, Delabays A, Favre J B, Ravussin P, von Segesser L K, Stumpe F
Service de chirurgie cardiaque, Hôpital de Sion, Lausanne.
Schweiz Med Wochenschr. 1998 Nov 28;128(48):1906-9.
To avoid the inflammatory syndrome generated by cardiopulmonary bypass, a new surgical technique, minimal invasive direct coronary artery bypass (MIDCAB), has been developed. An anastomosis is performed between the left internal mammary artery (LIMA) and the left anterior descending artery (LAD) on a beating heart, through a limited anterior thoracotomy. We describe our experience with this technique. Ten consecutive patients underwent a MIDCAB procedure. (9 males, age 65.9 +/- 9 years). There were 8 bypasses of the LIMA on the LAD, one bilateral mammary bypass on the LAD and the right coronary artery, and one conversion to a standard sternotomy with CPB for a saphenous vein bypass on the LAD because of injury to the LIMA (2nd case). There was one redo for haemostasis of the mammary artery bed (3rd case). The first 3 patients required postoperative blood transfusion. From the 4th operation onwards, with the introduction of new instrumentation which was better adapted to the narrowness of the surgical field, there were no further surgical complications. During the follow-up (mean 5 months; range 2-9), no patient suffered anginal recurrence. With the improvement of instrumentation, the MIDCAB technique offers satisfactory short- and mid-term results, while avoiding CPB with its adverse effects. Lastly, the cosmetic result is far better than with the conventional procedure.
为避免体外循环引发的炎症综合征，一种新的手术技术——微创直接冠状动脉搭桥术（MIDCAB）应运而生。通过有限的前外侧开胸术，在跳动的心脏上进行左乳内动脉（LIMA）与左前降支动脉（LAD）的吻合。我们在此描述我们应用该技术的经验。连续10例患者接受了MIDCAB手术（9例男性，年龄65.9±9岁）。其中8例为LIMA至LAD的搭桥，1例为LAD及右冠状动脉的双侧乳内动脉搭桥，1例因LIMA损伤（第2例）而转为在体外循环下标准胸骨切开术行LAD大隐静脉搭桥。有1例因乳内动脉床止血而再次手术（第3例）。前3例患者术后需要输血。从第4例手术开始，随着引入更适合狭窄手术视野的新器械，未再出现手术并发症。在随访期间（平均5个月；范围2 - 9个月），无患者出现心绞痛复发。随着器械的改进，MIDCAB技术提供了令人满意的短期和中期结果，同时避免了体外循环及其不良影响。最后，美容效果远比传统手术要好。
