Plötzlicher Tod bei Abriss eines LIMA-Bypasses

Zusammenfassung Bei koronarangiographisch gesicherter Eingefäßerkrankung am Herzen (betroffenes Gefäß: left anterior descendens, LAD) wurde bei einem 48 Jahre alten Mann eine sog. minimal-invasive direkte koronare arterielle Bypassoperation (MIDCAB) am schlagenden Herzen durchgeführt. Am 20. postoperativen Tag kam es unerwartet zur schnell progredienten Kreislaufverschlechterung. Bevor der Tod eintrat, konnte lediglich ein Hämatothorax links aus unklarer Ursache diagnostiziert werden. Bei der gerichtlich angeordneten Obduktion fanden sich 1 l Blut in der linken Brusthöhle sowie Blutkoagel im eröffneten Herzbeutel. Die distalen 4 cm der linken A. mammaria interna (LIMA) waren im Rahmen der Bypassoperation mobilisiert und durch den Herzbeutel geführt worden. An der Innenseite des Herzbeutels zeigte sich der 0,5 cm lange Stumpf der A. mammaria interna, der sich nur unter Zug mit einem korrespondierenden Gefäßstumpf an der Herzvorderwand zusammenführen ließ. Die Anastomose an der LAD stellte sich regelrecht dar. Das Ermittlungsverfahren gegen die Operateure wurde eingestellt. Morphologische und gutachterliche Aspekte des Falles werden dargestellt.     

Clinical experience with the Ventrica distal anastomotic device in coronary surgery

The surgical treatment of coronary artery disease is based on bypassing demonstrated lesions with autogenous vascular grafts. The operations have traditionally been invasive, complicated procedures requiring skillful microvascular surgical technique, cardiopulmonary bypass, and temporary cardioplegia. Ventrica, Inc. has developed a coupling device based on magnetic attraction which simplifies the connection of the graft to the coronary artery. Perceived advantages are shortened operating time, the need for less operative exposure, ease of use, versatility, and reliability. Use of the device is easily learned. It is a gentle technique which may be abandoned at any point without grossly noticeable consequence; the vessel remains apparently undamaged and remains suitable for hand‐sewn anastomosis. Patient recovery is swift and acceptance high. Immediate operative results, pre‐discharge angiograms and 6 month follow up angiograms are all favorable. The device is applicable to multiple graft operations, to all autogenous graft conduits, to end or sequential anastomoses, and to potentially all coronary vessels.     

Reviewing hybrid coronary revascularization: challenges,controversies and opportunities

Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice.     

Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions

Objective

The purpose of this study was to investigate the outcomes of patients undergoing advanced hybrid coronary revascularization, defined as robotic beating-heart multivessel totally endoscopic coronary artery bypass combined with percutaneous coronary intervention.

机器人辅助冠状动脉搭桥术4例报告

目的:微创手术是将来外科的发展方向,机器人在心脏外科领域应用越来越广。本文报告4例机器人辅助冠状动脉搭桥术的临床经验。方法:2001年3月～2002年4月,共有4例冠心病患者接受机器人辅助冠状动脉搭桥术,均为男性,平均年龄62±5岁。1例有心肌梗死史。1例为PTCA术后再狭窄,1例PTCA未成功。冠状动脉造影示左前降支单支病变,狭窄程度90％～100％。平均LVEF55％±9％。在胸腔镜、AESOP 3000机器人辅助下左取乳内动脉,经左第4肋间前外侧小切口完成左乳内动脉与左前降支直接吻合(MIDCAB)。结果:全组无手术死亡和围术期并发症。手术时间平均1.5h,其中取LIMA时间0.5h。平均胸腔引流量150ml,无1例输血。平均ICU时间18h,平均住院时间5.5d。病人疼痛较轻,感觉满意。结论:机器人辅助冠状动脉搭桥术创伤小,恢复快。     

Reoperative minimally invasive axillocoronary artery bypass to the obtuse marginal branch

A 73-year-old man was admitted with unstable angina, having severe coronary artery disease involving 3 vessels. He had undergone coronary artery bypass grafting to the left anterior descending artery and the obtuse marginal branch using saphenous vein grafts in 1979. Computed tomography showed severe calcium deposition and atherosclerosis in the ascending and descending aorta. We conducted axillocoronary artery bypass to the obtuse marginal branch and left internal thoracic artery as an in situ graft to the left anterior descending artery without cardiopulmonary bypass. Grafts were satisfactory and clinical results good.