经左胸前外侧小切口冠状动脉旁路移植术

目的 评价经左胸前外侧小切口冠状动脉旁路移植术的临床疗效及远期随访结果.方法 2002年1月至2006年10月,38例单支或多支冠状动脉病变患者经左胸前外侧小切口进胸,直视下或胸腔镜辅助下,完成非体外循环冠状动脉旁路移植术.其中男性25例.女性13例;年龄38～78岁,平均(63.3±11.1)岁.结果 38例手术均顺利完成.20例行单纯旁路移植1支;10例先行支架植入,后行胸廓内动脉至前降支端侧吻合,其中2例行胸廓内动脉与第一对角支、前降支序贯吻合;8例行旁路移植2支,其中3例为序贯吻合,5例应用桡动脉行"Y"形吻合.术后无死亡及严重并发症.37例患者获得26～82个月随访,平均(53.2±28.5)个月;无晚期死亡,无再发心肌梗死.心功能Ⅰ级26例,Ⅱ级12例.3例心绞痛复发,2例经药物控制后症状缓解,1例经造影证实吻合口狭窄于术后2年行支架植入.结论 左前外侧小切口非体外循环冠状动脉旁路移植术具有较低的病死率和心脏不良事件发生率,远期结果良好.

The clinical effect and long-term follow-up of minimally invasive direct coronary artery bypass grafting via left anterior small thoracotomy

Objective To estimate the clinical effect and long-term follow-up of minimally invasive direct coronary artery bypass grafting (MIDCAB) via left anterior small thoracotomy. Methods MIDCAB via left anterior small thoracotomy approach was performed in 38 cases of coronary artery disease with single or multi-vessel involvement from January 2002 to October 2006. There were 25 males and 13 females with a mean age of (63. 3 ± 11.1) years old The left internal mammary artery (LIMA) was harvested under direct vision or with the assistance of thoracoscopy. After heparinization the pericardium was directly opened to expose the target vessels. The coronary artery bypass grafting was completed on beating heart. Results The procedure were smoothly completed in all the 38 cases. The LIMA was anastomosed to the left anterior descending artery (LAD) or the diagonal artery in 20 cases, while two bypass grafts were pedormed in 8 cases (including 3 cases of sequential grafting and 5 cases of LIMA-radial artery Y-shaped grafting). Hybrid procedure was performed on 10 patients. There were no serious postoperative complications and operative deaths found. All the 38 cases except one were followed for 26 to 82 (53.2±28.5) months and no myocardial infarction or death occurred. NYHA class were Ⅰ in 26 cases and Ⅱ in 12 cases. There were 3 recurrence of angina, 2 patients relieved their symptoms with medication while 1 patient received stent implantation because of anastomose stenosis confirmed by coronary angiagraphy 2 years after surgery. Condusions MIDCAB via left anterior small thoracotomy has low rate of mortality and adverse cardiac events. The long-term follow-up is good.