经左前外侧小切口不停跳冠状动脉旁路移植术治疗多支血管病变的临床研究

目的分析经左前外侧小切口行不停跳冠状动脉旁路移植术(CABG)治疗多支血管病变冠状动脉粥样硬化性心脏病(冠心病)的安全性和随访结果。方法回顾性分析2018年1月至2020年3月在我院行左前外侧小切口不停跳CABG 30例多支血管病变冠心病患者的临床资料,其中男18例、女12例,平均年龄(61.3±7.5)岁;三支血管病变14例,两支血管病变16例。结果应用左侧乳内动脉到左前降支搭桥29支,其余应用大隐静脉到相应靶血管搭桥,平均搭桥桥血管数量(2.3±0.5)支。全组无围术期死亡,术后因出血二次开胸1例,发生急性肾功能不全1例。术后平均气管插管时间(16.0±5.8)h,术后住ICU时间(30.1±11.5)h。术后完成随访25例,于术后半年和1年行冠状动脉CT血管造影随访检查。发现近端吻合口狭窄1例,远端桥血管闭塞1例。结论对于选择合适的患者,应用左前外侧小切口行不停跳CABG是安全的。

On-pump coronary artery bypass grafting for the treatment of multivessel diseases via left anterolateral minithoracotomy

Objective To analyze the safety and follow-up results of on-pump coronary artery bypass grafting(CABG)for the treatment of multivessel diseases via left anterolateral minithoracotomy.Methods From January 2018 to March 2020,a total of 30 patients including 18 males and 12 females with an average age of 61.3±7.5 years having multivessel coronary heart diseases were treated in our hospital with on-pump CABG via left anterolateral minithoracotomy.Among them,14 patients had three-vessel diseases and 16 patients had two-vessel diseases.Results There were 29 internal mammary artery-to-left anterior descending bypass grafts harvested in total while the rest were saphenous-vein bypass grafts.The average number of bypass vessels was 2.3±0.5.There was no perioperative death in the whole group,one patient underwent rethoracotomy due to hemorrhage,and one patient suffered acute renal insufficiency.The average time of postoperative tracheal intubation was 16.0±5.8 hours,and the postoperative ICU stay was 30.1±11.5 hours.Twenty five patients were followed up,including coronary CT angiography examinations at 6 months and 1 year after operation.Proximal anastomotic stenosis in one patient and distal anastomosis occlusion in one patient occurred.Conclusion On-pump CABG via left anterolateral minithoracotomy is safe for appropriately selected patients.