Minimally invasive thoracoscopically assisted coronary artery bypass surgery
Minimally invasive thoracoscopically assisted coronary artery bypass surgery
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DOI：
10.1016/s1010-7940(97)00141-3
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发表时间：
1997-07-01
影响因子：
3.4
通讯作者：
Carter, D
中科院分区：
文献类型：
--
作者：
Mack, M;Acuff, T;Carter, D
目的：微创技术已广泛应用于其他外科领域，包括胸外科的电视胸腔镜手术（VATS），这些概念现在正被应用于心脏外科。使心脏手术创伤更小的机会包括消除正中胸骨切开术切口，消除心肺转流术和不操纵主动脉。材料与方法：从1992年1月至1996年9月，微创心脏手术的各个方面已经在无生命的内窥镜训练器，动物模型中进行了检查。人尸体和人临床研究。首先在无生命的训练者中完善了内窥镜缝合吻合术以及替代缝合术的技术，然后20只动物在轴流泵的循环支持下使用左乳内动脉至左前降支进行内窥镜冠状动脉搭桥术。在胸腔镜辅助下进行了58例微创冠状动脉搭桥手术，用于内乳动脉采集。结果如下：在无生命训练机上进行了150例内镜冠状动脉造影术，内镜下冠状动脉造影技术是首选方法。随着技术和器械的发展，进行吻合术所需的时间从60分钟以上减少到平均20分钟。在动物中，开发了入路方法以及允许主动脉交叉夹闭和吻合术性能的手术器械，58名人类在跳动心脏上通过有限的前胸廓切开术在直视下使用放置在左前降支的左乳内动脉进行冠状动脉搭桥术。程序二;由于52例患者成功，6例患者需要转换，因此开发了用于执行吻合术的固定技术。讨论内容：进行内窥镜吻合术的能力仍然是完全内窥镜冠状动脉搭桥手术的限速步骤。目前的MIDCAB（微创直接冠状动脉旁路移植术）手术是心脏手术的一个重大进步，但仍有局限性，使得精确吻合的性能仍然有些困难，仅适用于单支血管疾病。目前的努力旨在通过各种固定和循环支持装置来扩展MIDCAB手术，并将MIDCAB手术与导管技术相结合以治疗更晚期的疾病。(C)1997年Elsevier Science B.V.
Objective: Minimally invasive techniques have been widely used in other surgical fields including video-assisted thoracic surgery (VATS) in thoracic surgery, These concepts are now being applied to cardiac surgery. The opportunities to make cardiac surgery less invasive include elimination of the median sternotomy incision, elimination of cardiopulmonary bypass and no manipulation of the aorta. Materials and methods: From January 1992 through September 1996, various aspects of minimally invasive cardiac surgery have been examined in the inanimate endoscopic trainer, animal model. human cadaver and in human clinical studies. Techniques of endoscopic sutured anastomosis as well as alternatives to suturing were first perfected in the inanimate trainer, Twenty animals then underwent endoscopic coronary artery bypass using the left internal mammary artery to the left anterior descending with circulatory support from an axial flow pump. Fifty eight minimally invasive coronary artery bypass procedures have been performed in humans using thoracoscopic assistance for internal mammary artery harvest. Results: One hundred fifty endoscopic coronary anastomoses were performed in the inanimate trainer with the endoscopic suturing technique being the preferred method. Time required to perform an anastomosis decreased from greater than 60 min to a mean of 20 min as technique and instruments were developed. In animals, methods of access as well as enabling surgical instruments to allow crossclamp of the aorta and performance of the anastomosis were developed, Fifty-eight humans underwent coronary artery bypass using the left internal mammary artery placed to the left anterior descending under direct vision through a limited anterior thoracotomy on a beating heart. The procedure ii;as successful in 52 patients with conversions required in six patients, Techniques were developed for immobilization for performance of the anastomosis. Discussion: The ability to perform an endoscopic anastomosis still remains the rate limiting step for totally endoscopic coronary artery bypass surgery. The present MIDCAB (minimally invasive direct coronary artery bypass grafting) procedure is a significant advance in cardiac surgery, but still has limitations that make performance of an exact anastomosis still somewhat difficult and applicable only to single-vessel disease. Present efforts are directed toward extending the MIDCAB procedure by various immobilization and circulatory support devices and combining the MIDCAB procedure with catheter techniques for treating more advanced disease. (C) 1997 Elsevier Science B.V.