机器人辅助的微创冠状动脉旁路移植术

目的：介绍机器人辅助的微创冠状动脉旁路移植手术。方法：应用da Vinci机器人系统取左乳内动脉,然后经左胸第2肋间小切口在体外循环下行冠状动脉旁路移植术。结果：本组34例患者无围术期死亡和心肌梗死;术后有4例发生低心排血量综合征,2例发生急性肾功能不全。结论：机器人辅助的微创冠状动脉旁路移植术是一种安全可靠的手术方法,可以减轻术后疼痛和促进术后恢复。     

非体外循环冠状动脉旁路移植术153例体会

目的　探讨非体外循环冠状动脉旁路移植术无手术死亡的治疗体会。方法　回顾性分析近 4年来 15 3例非体外循环冠状动脉旁路移植术的临床资料。结果　全组无手术死亡。平均搭桥 3 .1支 ,无围手术期心肌梗死、呼吸衰竭、肝肾功能衰竭等并发症 ,92 %患者术后 4～ 6h拔除气管内插管 ,5 6%患者未输血 ,术后心绞痛均消失。结论　非体外循环冠状动脉旁路移植术安全、有效 ,术后并发症少 ,正确掌握其手术适应证、手术配合、手术技巧和围手术期处理 ,是确保手术疗效的关键。     

微创体外循环对冠状动脉旁路移植术的临床效果观察

目的 观察微创体外循环(MECC)对冠状动脉旁路移植术临床效果的影响.方法 将60例在我院行进行冠状动脉旁路移植术的患者分为MECC组、传统的心肺旁路(CCPB)组各30例.记录患者术中、术后各项临床指标并进行分析.结果 两组患者年龄、性别、体表面积、术前血红蛋白、术前血球压积以及左室射血分数比较,差异无统计学意义.术中两组病例阻断时间和总转流时间均无差异,但转中最低血红蛋白和体外用血量存在明显差异(P ＜0.001).ICU红细胞用量MECC组少于CCPB组(P＜0.05);ICU机械通气时间MECC组明显少于CCPB组;ICU住院时间两组无差异.ICU第一个24小时胸引量MECC组少于CCPB组(P＜0.05).结论 MECC与CCPB相比,在冠状动脉旁路移植术中是安全可靠的,能大幅减少血液制品的使用.     

153例非体外循环冠状动脉旁路移植术

目的总结153例非体外循环冠状动脉旁路移植术患者无手术死亡的治疗经验. 方法回顾性分析近4年来153例非体外循环冠状动脉旁路移植术的临床资料、手术方法、手术结果. 结果全组无手术死亡.每例平均移植旁路血管3.1支,全组无围手术期心肌梗死、呼吸衰竭、肝肾功能衰竭等并发症,141例患者术后4～6小时拔除气管内插管,86例患者未输库血,术后心绞痛均消失.所有患者均获随访,随访时间2～42个月,无晚期死亡.1例患者于术后1年6个月出现活动后胸闷、心绞痛,其余患者症状均消失,活动量明显增加,心功能改善. 结论非体外循环冠状动脉旁路移植术安全、有效,术后并发症少,正确掌握其手术适应证、手术技巧和围术期处理,是确保手术疗效的关键.     

非体外循环和体外循环冠状动脉旁路移植术在二次冠状动脉旁路移植术中的应用

目的研究对比在二次冠状动脉旁路移植术(re-CABG)患者中分别采用非体外循环和体外循环下冠状动脉旁路移植术(off-pump CABG和on-pump CABG)的临床早期结果,探讨通过合理手术方式的选择,提高re-CABG的手术疗效。方法自2000年4月到2006年6月,21例首次CABG后因心绞痛复发患者在阜外心血管病医院接受了re-CABG手术,其中10例行off-pump CABG(off-pump组),11例行on-pump CABG(on-pump组)。两组患者术前性别、年龄、体重、心肺功能、心绞痛程度、左心室舒张期末内径、射血分数、合并高血压、糖尿病等方面差异无统计学意义(P>0.05)。结果 On-pump组中患者术后死亡1例,冠状动脉远端吻合口数多于off-pump组(P<0.05);off-pump组无手术死亡,在手术时间、术后呼吸机辅助时间、胸腔引流液量、输血量和手术后住院时间等方面,均明显少于on-pump组(P<0.05)。结论 Off-pump CABG和on-pump CABG技术在re-CABG中都可以取得满意疗效,off-pump CABG下施行re-CABG安全可靠。     

非体外循环下冠状动脉旁路移植术

目的　探讨和评价微创非体外循环冠状动脉旁路移植术 (OPCAB)的临床效果。　方法　 38例 OPCAB患者中左冠状动脉主干病变 4例 ,1支血管病变 10例 ,2支 14例 ,3支 10例 ,均经胸骨正中切口行 OPCAB,每例移植血管 1～ 5支 ,平均移植血管 2 .42支。应用左乳内动脉 38支 ,大隐静脉 5 4支。　结果　全组无手术死亡 ,36例顺利完成手术 ,2例转为心肺转流术下冠状动脉旁路移植术。38例均在手术后 2～ 12小时 ,平均 4.9± 2 .6小时顺利拔除气管内插管。全组均顺利康复 ,15例手术后 1个月内恢复了原工作。　结论　对有适应证的患者 ,OPCAB是一项安全有效的术式     

非体外循环下冠状动脉旁路移植术

目的 报告微创非体外循环冠状动脉旁路移植术(OPCABG),探讨其手术指征及外科处理要点。方法 回顾性总结5例OPCABG的临床资料。结果 5例顺利完成非体外循环冠状动脉旁路移植术。随访3～4个月,无死亡,无明显心绞痛及心肌缺血表现。结论 对于选择的患者,OPCABG安全、经济、有效,是一种值得推广的微创心脏手术方法。     

微创冠状动脉旁路移植术学习曲线分析

目的 探讨微创冠状动脉(冠脉)旁路移植术(minimal invasive coronary artery bypass grafting,MICSCABG)手术时间的变化学习曲线及其对围术期临床效果的影响.方法 纳入本中心2012年3月至2020年11月212例连续由同一位外科医生完成的不停跳MICS CABG患者,...     

冠状动脉旁路移植术体外循环243例

1997年 1月～ 2 0 0 0年 12月 ,我科在体外循环 (CPB)下行冠状动脉旁路移植术 (CABG) 2 4 3例 ,现报告如下。1　临床资料与方法1.1　一般资料　本组共 2 4 3例 ,男 2 15例 ,女 2 8例 ;年龄2 0～ 75岁 ,平均年龄 5 7.5 9± 10 .6 7岁 ;体重 4 0～ 94 kg,平均体重 72 .4 9± 10 .92 kg。术前左心室射血分数 0 .2 4～ 0 .87,平均 0 .5 7± 0 .11;心功能≥ 级 12 5例 ;冠状动脉病变≥ 3支181例。全组均行 CABG,同期行室壁瘤切除术 11例 ,心瓣膜置换术 15例。1.2　方法　经升主动脉插管和腔房二级引流管建立 CPB。常规监测静脉血混合氧饱…     

微创冠状动脉旁路移植手术33例报告

目的探讨微创冠状动脉旁路移植手术(minimally invasive direct coronary artery bypass graft,MIDCABG)的可靠性及安全性. 方法 2001年3月～2003年9月,我院在全麻、非体外循环、心脏不停跳下进行了33例单支MIDCABG.14例采用左前外侧小切口,19例采用胸骨下段正中切口.31例行左乳内动脉至前降支旁路移植,1例使用大隐静脉行主动脉根部至前降支旁路移植,1例行胃网膜右动脉至后降支旁路移植. 结果全组无手术死亡.术中出血量(163±120)ml,术后引流量(193±169)ml,术后拔管时间(6.4±5.5)h,ICU时间(17.8±4.4)h.随访(14.7±7.4)月,无死亡. 结论 MIDCABG安全可靠,具有创伤小、出血量少、并发症少的优点.     

Robotically enhanced coronary artery bypass surgery

Robotically enhanced telemanipulation surgery is a rapidly developing technique which enables totally endoscopic cardiac surgery with utmost precision and perfection on both beating heart and arrested heart. Between December 2002 and September 2006, 268 patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system. Fourteen patients underwent total endoscopic coronary artery bypass surgery. Of these 12 were performed on a beating heart and 2 on an arrested heart. Two-hundred and fifty-four patients had endoscopic takedown of the internal mammary artery followed by minimally invasive direct coronary artery bypass in 193 patients and left anterolateral thoracotomy in 61 patients. The internal mammary artery mobilization time was 36 min (28–76 min) and the left internal mammary artery to left anterior descending artery anastomosis time ranged from 20 to 36 min for the totally endoscopic coronary artery bypass patients. The right internal mammary artery of one patient was anastomosed to diagonal artery totally endoscopically. The mean internal mammary artery flow by Doppler measurement in patients undergoing minimally invasive direct coronary artery bypass was 58 ml min⁻¹. Seven patients required conversion to median sternotomy and coronary bypass surgery on the beating heart. The mean intensive care unit stay was 1.2 days and the mean hospital stay 4.5 days. There was one in-hospital mortality. All 14 patients who underwent total endoscopic bypass surgery had coronary angiography 3 months later which showed 100% patency in 13 patients. One patient had 50% anastomotic narrowing for which coronary angioplasty was performed in the same sitting. By using telematic technology, a complete endoscopic anastomosis is possible in both single vessels and suitable double vessel disease patients. The use of robotics is now extended to achieve complete myocardial revascularization by harvesting both the internal mammary arteries and making a small thoracotomy for direct anastomosis also.     

Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study

Objective: The minimally invasive coronary artery bypass grafting (MICS CABG) operation performed via a small thoracotomy has not previously been examined in a direct comparison to sternotomy off-pump coronary artery bypass grafting (OPCAB). Methods: We matched, according to age, gender, left ventricular function, and median number of distal anastomoses, 150 patients who underwent MICS CABG via small left thoracotomy, and 150 patients who received sternotomy OPCAB. All operations were performed by the same surgeon. Results: There was no perioperative mortality (0/300). In the MICS CABG group, pump assistance was used in 28/150 (19%) patients, and conversion to sternotomy occurred in 10/150 (6.7%) patients. In the OPCAB group, conversion to on-pump occurred in 3/150 (2.0%) patients. There were four (2.7%) reoperations for bleeding and one (0.7%) for anastomotic revision in each group. The median hospital length of stay was 5 days for MICS CABG (average 5.4), and 6 days for OPCAB (average 7.2) (P = 0.02). New-onset atrial fibrillation occurred in 35 (23%) MICS CABG patients and in 42 (28%) OPCAB patients (P = 0.3). No wound infection occurred with MICS CABG versus six (4.0%) with OPCAB (P = 0.03). A self-limiting left pleural effusion developed in 22 (15%) MICS CABG patients and in six (4.0%) OPCAB patients (P = 0.002). The median time to return to full physical activity was 12 days in MICS CABG patients versus >5 weeks in OPCAB patients (P < 0.001). Conclusions: MICS CABG is a valuable alternative for patients in need of multivessel CABG. The operation appears at least as safe as OPCAB, and associated with shorter hospital length of stay, less wound infections, and faster postoperative recovery than OPCAB.     

心脏不停跳非体外循环冠状动脉旁路移植术的进展

近年来，随着手术器械的发展，心脏不停跳非体外循环下冠状动脉旁路移植术(OPCAB)逐渐被广泛接受和应用。与常规冠状动脉旁路移植术(CCABG)比较，OPCAB的主要优势为血液中多种炎性介质浓度明显降低，避免了体外循环(CPB)带来的全身系统性炎性损害，减少了并发症，降低了手术死亡率。特别对那些不能采用CPB或采用CPB有风险的高危患者优势更明显。CCABG的手术适应证同样适用于OPCAB，但OPCAB具有相对的禁忌证。OPCAB多采用胸骨正中切口，左前外侧切口适用于左前降支单支病变。OPCAB术后早期结果类似CCABG，但中远期结果有待进一步观察。OPCAB大多数旁路移植血管数低于CCABG，有不能完全再血管化的可能，对OPCAB是否会影响吻合的精确性和旁路血管的长期通畅率有不同意见。OPCAB的优势明确，但仍不能完全替代CCABG，手术的同时应作好CPB准备，必要时改行CCABG。     

Reoperative coronary artery bypass grafting using a minimally invasive direct coronary artery bypass procedure

OBJECTIVE: Reoperative coronary artery bypass grafting with cardiopulmonary bypass tends to cause a higher mortality and morbidity than the primary operation. The purpose of this study was to discuss the effectiveness and safety of a minimally invasive coronary artery bypass procedure for patients who had previously undergone coronary artery bypass surgery. METHODS: We performed redo single coronary artery bypass grafting to the left anterior descending coronary artery in 9 patients and to the right coronary artery in 3 patients using minimally invasive cardiac surgery. The graft to the left anterior descending coronary artery was taken from the left internal thoracic artery in 5 patients, the right gastroepiploic artery in 3 patients, and from the saphenous vein in the other 1 patient. The graft to the right coronary artery was from the right gastroepiploic artery in all 3 patients. RESULTS: All grafts were patent. There was no major postoperative complication and no surgical or hospital death except one late death. CONCLUSIONS: In selected patients, we could safely and completely perform coronary artery bypass re-grafting to the left descending coronary artery or right coronary artery using a minimally invasive operation.     

微创冠状动脉旁路移植术处理前降支病变的围术期结果

目的研究胸腔镜辅助下经左胸小切口微创直视下冠状动脉旁路移植术(minimally invasive direct coronary artery bypass grafting,MIDCAB)处理前降支病变的围术期结果及其安全性。方法回顾性分析2014年5月至2018年10月在我院接受MIDCAB 92例患者的临床资料,其中男72例(78.26%),年龄42~78(61.29±7.48)岁,女20例(21.74%),年龄30~80(61.30±12.26)岁。分析围术期并发症发生率、血制品使用情况、左心功能变化情况、呼吸机使用时间、住ICU时间及住院时间等指标。结果2例(2.17%)患者中转正中开胸手术,5例(5.43%)术中输入血液制品,2例(2.17%)二次开胸止血,4例(4.34%)术后低氧血症,1例(1.08%)再次气管插管。呼吸机使用时间3~227(22.35±35.39)h,住ICU时间16~777(78.85±108.62)h,术后住院时间2~36(8.86±6.05)d。住院死亡1例(1.08%)。结论MIDCAB处理前降支病变具有较好的围术期结果,尤其适用于孤立性前降支病变,可缩短术后呼吸机使用时间、减少血液制品使用、缩短住ICU时间及住院时间。     

Off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction

Objective  Off-pump coronary artery bypass grafting (OPCAB) is known to preserve left ventricular function better than conventional coronary artery bypass grafting (CCAB). This study was carried out to investigate the safety, feasibility and efficacy of off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction. Methods  Three hundred and eighty eight consecutive patients with preoperative left ventricular ejection fraction ≤ 39% who underwent CABG between January 2001 through October 2007 were included in this retrospective study. Two hundred and eleven patients were operated by off-pump technique (group 1) and 178 patients were operated by on-pump technique (CCAB) (group 2). The postoperative outcomes were analyzed. Of these, 204 (52.57%) patients were diabetics, 355 (91.49%) patients had documented prior myocardial infarction, 316 (81.44%) patients were in canadian cardiovascular society(CCS) class III and 47 (12.11%) patients were in CCS class IV. Results  There was no significant difference in the number of grafts per patient between the two groups [group 1 3.02 ± 0.76 vs group 2 3.18 ± 0.72 (P=0.07) and the index of completeness of revascularization was comparable [1.08 ± 0.08) (OPCAB) vs 1.04 ± 0.06 (CCAB) (p=0.52)] The left internal thoracic artery was anastomosed to left anterior descending artery in 98% of patients. Operative mortality was 2.8% (6 deaths) following OPCAB and 3.93% (7 deaths) following CCAB (p=0746). Postoperative usage of IABP support was higher in CCAB group (12 patients vs 4 patients: P<0.03) and usage of moderate or higher doses of inotropic support was also higher in the conventional group (p<0.0006). More worsening of preexisting renal insufficiency was observed in CCAB group (p=0.01) and no significant difference in the incidence of atrial fibrillation was observed between the groups. Conclusions  Off-pump coronary artery bypass grafting is feasible and safe in patients with depressed left ventricular function and the postoperative morbidity was less in OPCAB group compared to on-pump group.     

肺动脉漂浮导管在冠状动脉旁路术中的应用

目的　评价肺动脉漂浮导管连续监测心排血量 (CO)、混合静脉血氧饱和度 (S VO2 )在冠状动脉旁路移植术 (CABG)中的应用。方法　CABG术者 32例 ,年龄 (6 1 31± 6 92 )岁 ,平均搭桥(3 19± 1 12 )支。麻醉诱导用芬太尼 2 0～ 30 μg/kg、维库溴铵 0 3mg/kg、咪唑安定 (3 5 8± 2 0 0 )mg ;术中以芬太尼、异氟醚维持。经右颈内静脉置CCO S VO2 肺动脉漂浮导管 ,连续监测CO、S VO2 、平均动脉压 (MAP)、肺动脉压 (PAP)、肺毛细血管楔压 (PCWP)和中心静脉压 (CVP)等 ,记录诱导前、插管后、心肺转流 (CPB)前、停CPB及关胸时的数据。结果　心排指数 (CI)、MAP和S VO2 在插管后各时段较诱导前明显下降 (P <0 0 5 ) ,CVP、PCWP及PAP停CPB后较插管后升高 (P <0 0 5 )。HR在插管后下降 (P <0 0 5 ) ,停CPB后升高 (P <0 0 5 )。结论　在CABG术中 ,利用肺动脉漂浮导管连续监测CO、S VO2 及各项相关指标 ,及时了解心脏功能、全身及心肌的氧供需平衡状况 ,并调整用药 ,以利于围手术期意外的处理 ,防止心肌缺血的发生     

Female sex as a risk factor in minimally invasive direct coronary artery bypass grafting

Objectives. Female sex has been generally accepted as a risk factor for short-term mortality and adverse events in surgical myocardial revascularization. However, there have been no data published yet about sex differences in minimally invasive settings. The aim of our study was to analyse short- and long- term outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) in terms of sex comparison. Design. We retrospectively analysed the in-hospital data of all patients (n?=?384) undergoing MIDCAB at our department in years 2006-2016. Subsequently, the data were enriched by long-term outcomes from national registries. Results. There were 96 women in our group (25%). Females were significantly older (67.1 vs 63.8 years; p?p?p?=?.02), and also the need for blood transfusion (19.8% vs 10.4%; p?=?.02) and wound complications (15.6% vs 2.4%; p?p?p?p?=?.26), long-term mortality (p?=?.73), and the risk of coronary intervention post-operatively (p?=?.16) were the same in both sexes. Higher incidence of cardiac cause of death in women was observed from long-term aspect (69.6% vs 38.7%; p?=?.01). However, after adjustment it lost its significance. Conclusions. Female sex is not connected with higher risk of mortality or other major events in MIDCAB. Wound healing complications remain the leading attribute associated with female sex.