微创经左胸小切口非体外循环单支、多支冠状动脉旁路移植术33例

目的 探讨左侧肋间小切口非体外循环单支、多支冠状动脉旁路移植术的安全性和可行性。方法 回顾性分析2014年5月~2019年10月左胸前外侧小切口非体外循环下冠状动脉旁路移植术33例资料。单支病变17例，多支病变16例。左胸前外侧小切口6cm-10cm，直视下获取左乳内动脉(LIMA)，完成LIMA-左前降支(LAD)吻合，升主动脉（Ao）-大隐静脉(SVG)序贯-对角支(D)或中间支（ICA）-钝缘支(OM)-后降支(PDA)或左室后支(PLV)共2~4支旁路移植血管吻合。结果 全组LIMA-LAD桥32例，Ao-SVG-LAD 1例。Ao-SVG-D 2例，Ao-SVG-OM 2例、Ao-SVG-OM-PDA 2例，Ao-SVG-ICA-PDA 3例，Ao-SVG-D-OM-PDA 4例，Ao-SVG-D-OM-PLV 3例。33例手术均顺利完成，围术期无死亡、心肌梗死、脑卒中、呼吸衰竭、肾功能衰竭、切口感染等并发症。术后呼吸机时间7h~18 h(9.14±3.82)h；ICU时间6h~20 h（12±8）h。术后住院5d~11d(8±3)d。出院时复查冠状动脉CT，33例均提示左乳内动脉桥、大隐静脉序贯桥通畅性良好。随访3个月~3年，平均8个月，无死亡、心绞痛和心肌梗死。30例复查冠状动脉, LIMA桥、SVG序贯桥通畅性良好。结论 左侧肋间小切口非体外循环下多支冠状动脉旁路移植术安全可行。

The clinical effect of 33 patients who undertook minimally invasive with single vessel anastomosis or multivessel off-pump coronary artery bypass grafting via left anterior small thoracotomy

Objective:This study aims to discuss the safety and feasibility of Coronary artery bypass grafting with single or multiple branches without extracorporeal circulation using the small intercostal incisionMethods:This study conducts a retrospective analysis of 33 cases of coronary artery bypass grafting with single or multiple branches without extracorporeal circulation using small intercostal incision from May 2014 to October 2019. There were 17 cases of single-vessel disease and 16 cases of the multiple-vessel disease. A small incision 6cm-10cm in the left anterior lateral of the thorax. Obtain the left internal mammary artery (LIMA) under direct vision, complete the LIMA-left anterior descending branch (LAD) anastomosis, ascending aorta (Ao)-great saphenous vein (SVG) sequence-right Angle branch (D) or middle branch (ICA)-blunt margin branch (OM)-posterior descending branch (PDA) or posterior branch of the left ventricle (PLV) a total of 2 to 4 bypass grafts were anastomosed. Results: There were 32 LIMA-LAD bypass grafts and 1 Ao-SVG-LAD in the whole group. Ao-SVG-D 2 cases, Ao-SVG-OM 2 cases, Ao-SVG-OM-PDA 2 cases, Ao-SVG-ICA-PDA 3 cases, Ao-SVG-D-OM-PDA 4 cases, Ao- 3 cases of SVG-D-OM-PLV. Thirty-three cases were successfully completed, and there were no complications such as death, myocardial infarction, stroke, respiratory failure, renal failure, and incision infection during the perioperative period. Postoperative ventilator time was 7h ~ 18h (9.14 ± 3.82) h; ICU time was 6h ~ 20h (12 ± 8) h. 5d ~ 11d (8 ± 3) d after hospitalization. On discharge, the coronary CT was reviewed, and 33 patients all suggested that the left internal mammary artery bypass grafts and the great saphenous vein sequential graft had good patency. Followed up for 3 months to 3 years, an average of 8 months, without death, angina, and myocardial infarction. Coronary arteries were reexamined in 30 cases, and the patency of the LIMA bypas graft and SVG sequential bypas graft was good. Conclusion: Multi-branch coronary artery bypass grafting with small left intercostal incision without cardiopulmonary bypass is safe and feasible.