Symmetry吻合装置应用于非体外循环冠状动脉旁路移植

目的:报告临床应用桥血管-主动脉吻合装置,在非体外循环冠状动脉旁路移植手术的初步经验,探讨其可行性与安全性。方法:2003年10月-12月,23例在非体外循环下冠状动脉旁路移植(OPCAB)手术中应用Symmetry桥血管-主动脉吻合装置实现主动脉无钳夹技术。4例患者伴有严重的升主动脉钙化性粥样硬化。应用吻合装置完成近端吻合口共计59个,平均2.6个/例。术前应用升主动脉薄层CT平扫评价其粥样硬化及钙化程度,术中采用升主动脉超声检查结合手指扪查升主动脉的方法,避开钙化斑块,进行近端吻合口的定位。再血管化的顺序为:(1)左乳内动脉与左前降支远端吻合;(2)应用主动脉无钳夹技术,以吻合装置完成所有静脉桥血管与主动脉近端吻合;(3)顺次完成所有静脉桥血管与冠状动脉远端吻合。术后以抗血小板药物治疗6个月。术后患者均接受门诊或电话随访。结果:全组应用吻合装置完成近端吻合口59个均获得成功,术中未发现吻合口漏血需手工缝合修补情况。全组无手术死亡病例。围术期未发生心肌梗死。无脑血管意外、二次开胸止血、心功能衰竭等严重围术期并发症。术后1年随访,发现23例患者中有2例心绞痛症状复发,其中1例复查冠状动脉造影证实所有桥血管均通畅。另1例患者未能复查冠状动脉造影,于术后18个月死亡。结论:Symmetry桥血管-主动脉吻合装置可以安全地应用于OPCAB手术。特别是为实现冠脉手术的主动脉无钳夹技术,以解决升主动脉钙化问题,提供了一种可选择的方法。但其对于静脉桥血管远期通畅率的影响值得关注,并有待进一步大组病例临床研究的证实。

Primary Experience of Symmetry Aortic Connector Device for Proximal Anastomoses in Off Pump Coronary Artery Bypass Grafting

Objective: To report our primary experience of aortic no clamping technique by using Symmetry aortic connector device for proximal vein graft anastomoses, and to evaluate the efficacy and safety of this device. Methods: Between October to December 2003, Symmetry aortic connector devices for proximal vein graft anastomoses were applied in 23 patients undergoing OPCAB. 4 patients were combined with severely calcified atherosclerosis in the ascending aorta. A total of 59 proximal vein graft anastomoses were performed with the connectors, averagely 2.6 per patient. Intraoperative ultrasonic examinations of the ascending aorta combined with finger palpation were performed to avoid calcified plaques in the ascending aorta in order to properly choose the site for the connector's delivery. The sequence of revascularization was: (1)LIMA to LAD. (2) Aortic no clamping technique to accomplish proximal vein graft anastomoses by using the aortic connector devices. (3)Distal vein graft to coronary artery anastomoses. Patients received anti-platelets medications for 6 months after surgery. All patients were followed up post-operatively. Results: All 59 vein graft anastomoses were performed with the connector uneventfully, there was no leakage from the connector which needed hand sew repair. There was no postoperative in-hospital mortality, no severe postoperative complications such as myocardial infarction, stroke or re-open for bleeding. Follow-up of the 23 patients one year after sugery revealed that 2 patients had reoccur of angina symptom. One of this two patients received coronary angiography during follow-up, which revealed that all grafts were patent. The other patient expired 18 months after his first operation. Conclusion:Symmetry aortic connector device for proximal vein graft anastomoses could be used safely in off pump coronary artery bypass procedures. Particularly, it could be considered as one of the different surgical solutions as aortic no clamping technique, to be used in coronary patients with severely calcified ascending aortic atherosclerosis. However, attention should be paid to the long term vein grafts patency rate, which remains to be e-valuated in further clinical study.