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"Single suture" for circumflex exposure in off pump coronary artery bypass grafting

ANNALS OF THORACIC SURGERY 1999年第4期68卷 1428-1430页

作者： Bergsland, J Karamanoukian, HL Soltoski, PR Salerno, TA Kaleida Hlth Ctr Less Invas Cardiac Surg Buffalo NY 14203 USA SUNY Buffalo Buffalo NY 14260 USA

Exposure of coronary vessels in the circumflex territory for surgery off cardiopulmonary bypass (CPB) is a challenge. Ricardo Lima from Brazil described a series of sutures that enable surgeons to expose the marginal circumflex vessels on the beating heart. We have modified this technique and only use a "single suture" placed in the oblique sinus of the posterior pericardium. This allows for successful exposure of all coronary vessels with minimal manipulation of the heart. This simple technique enhances surgery on the beating heart and is especially useful to bypass topographically "difficult" posterior and lateral coronary vessels. (C) 1999 by The Society of Thoracic Surgeons.

关键词：心肺转流术冠状动脉分流术/仪器和设备冠状血管/外科学心包/外科学外科器械缝合技术/仪器和设备人类

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Direct aortic cannulation for port-access mitral or coronary artery bypass grafting

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ANNALS OF THORACIC SURGERY 1999年第5期68卷 1878-1880页

作者： Glower, DD Komtebedde, J Clements, FM Debruijn, NP Stafford-Smith, M Newman, MF Duke Univ Med Ctr Dept Surg Durham NC 27710 USA Duke Univ Med Ctr Dept Anesthesia Durham NC 27710 USA

A technique is described for direct aortic arterial cannulation during Port-Access mitral valve or coronary artery bypass grafting. Femoral arterial cannulation is avoided, and endoaortic balloon occlusion is used for cardioplegic arrest. To date, excellent results have been obtained in 45 patients. (C) 1999 by The Society of Thoracic Surgeons.

关键词：主动脉胸/外科学导管留置冠状动脉分流术/仪器和设备设备设计心脏瓣膜假体植入/仪器和设备二尖瓣/外科学穿刺术/仪器和设备外科手术微创性人类

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Early experience with robotic technology for coronary artery surgery

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1542-1546页

作者： Boehm, DH Reichenspurner, H Gulbins, H Detter, C Meiser, B Brenner, F Habazettl, H Reichart, B Univ Hosp Munich Grosshadern Dept Cardiac Surg D-81366 Munich Germany Univ Hosp Munich Grosshadern Inst Surg Res Munich Germany

Background. To achieve an endoscopic coronary bypass anastomoses we performed a study with endoscopic robotic instrumentation and camera guidance using three-dimensional (3-D) visualization. Methods. The surgical robotic system ZEUS (Computer Motion Inc, Goleta, CA) consists of three interactive robotic arms and a control unit allowing the surgeon to move the instrument arms in a scaled down mode. The third arm (AESOP, Computer Motion Inc, Goleta, CA) positions the endoscope via voice control. The study had three phases. Phase I: In a phantom model, end-to-side anastomoses between vein grafts and the left anterior descending coronary artery (LAD) of 109 pig hearts were performed. Phase II: In 6 dogs (FBI, 20-25 kg) the left internal mammary artery (LIMA) was harvested endoscopically. During Port-Access (Heartport Inc, Redwood City, CA) cardiopulmonary bypass (CPB), LIMA and LAD were then anastomosed endoscopically with the help of telemetric ZEUS instruments (Computer Motion Int). Phase III: A total of seven patients were operated on with help of the ZEUS system (Computer Motion Inc), After endoscopic LIMA harvesting and CPB using the Port-Access (Heartport Inc) system, the bypass graft (LIMA to LAD) was anastomosed endoscopically through three thoracic ports in 2 patients. Another 3 patients were operated on off-pump with regional stabilization and 2 patients with sternotomy and routine CPB. Results. The practice with the phantom model and the subsequent animal experiments allowed the surgeons to gain sufficient experience for the clinical setting. In the clinical cases, times for anastomoses ranged from 20 to 42 minutes. Median internal mammary artery how rate was 74 mt, per minute (range 36-110 mL per minute). One patient in the off-pump group was converted to CPB and routine anastomosis. All patients had an uneventful angiographic control and postoperative course. Conclusions. Using telemetic technology, a completely endoscopic anastomosis elf LIMA to LAD is pos

关键词：吻合术外科/仪器和设备冠状动脉分流术/仪器和设备内窥镜检查胸廓内动脉-冠状动脉吻合术/仪器和设备模型心血管心肌血管重建术/仪器和设备机器人外科设备猪遥测术/仪器和设备治疗结果动物狗人类

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Results of a prospective multicenter study on port-access coronary bypass grafting

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1475-1477页

作者： Grossi, EA Groh, MA Lefrak, EA Ribakove, GH Albus, RA Galloway, AC Colvin, SB NYU Med Ctr Sch Med New York NY 10028 USA Mem Mission Hosp Asheville NC USA Fairfax Hosp Falls Church VA 22046 USA

Background. We reviewed the initial patient series of three institutions performing large volume port-access (FA) coronary artery bypass grafting (CABG) to evaluate the efficacy of this new procedure. Methods. From October 1996 until June 1998, 302 consecutive patients underwent isolated CABG using the PA approach. Patients (mean age 60.7 years) were predominantly male (77.5%) and received a mean of 2.3 distal anastomoses;few were New York Heart Association class III or IV (15.9%). The distribution of the number of grafts was: 76 (25.2%) single, 110 (36.4%) double, 73 (24.2%) triple, and 43 (14.2%) four or more bypass grafts. The Society of Thoracic Surgeons (STS) Database data collection form was used prospectively by all three institutions to define patient risk factors and record outcomes. Results. Total 30-day hospital mortality was 0.99% compared to the STS-database-model-predicted risk of 1.2%. Complication rates for the PA CABG patients compared with risk-matched morbidity rates from the STS data for CABG alone were: reoperation for bleeding, 3.3% versus 1.9%;ventilatory support more than 1 day, 1.7% versus 3.8%;stroke, 1.7% versus 1.2%;and perioperative transmural myocardial infarction 0% versus 1.3%. Conclusions. The STS CABG risk-adjusted model demonstrates that the 30-day mortality for patients undergoing PA CABG is lower than predicted for traditional CABG patients (confidence intervals not available). Likewise, the morbidity was low, with minimal ventilatory support, pulmonary complications, and atrial fibrillation. The port-access technique is an acceptable strategy for multivessel bypass grafting. (C) 1999 by The Society of Thoracic Surgeons.

关键词：冠状动脉分流术/仪器和设备冠心病/外科学手术后并发症/死亡率前瞻性研究危险因素外科器械外科手术微创性/仪器和设备存活率胸廓切开术/仪器和设备治疗结果女(雌)性人类男(雄)性中年人

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Transabdominal endoscopic computer-enhanced coronary artery bypass grafting

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1555-1557页

作者： Falk, V Moll, FH Rosa, DJ Daunt, D Diegeler, A Walther, T Mohr, FW Univ Leipzig Ctr Heart D-7010 Leipzig Germany Intuit Surg Inc Mt View CA USA

Background. Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. Methods. A computer-enhanced surgical telemanipulation system was used to perform transabdominal endoscopic grafting (TCAB) in an experimental cadaver model. After incising the membranous portion of the diaphragm, pericardium, and pleura, dissection of the left (n = 10) and right internal thoracic arteries (n = 5) was performed. Coronary anastomoses were performed remotely and unassisted. In an animal model the hemodynamic consequences of the approach were assessed. Results. In all cadavers TCAB was achieved through three abdominal ports. Time for internal thoracic arteries harvest was 48 +/- 13 minutes (left) and 39 +/- 10 minutes (right). Intimal dissection was found in one graft. Time for anastomosis was 23 +/- 9 minutes and 27 +/- 10 minutes for the left anterior descending (n = 10) and right coronary artery (n = 5), respectively. All anastomoses were patent. Opening the diaphragm in living animals led to a decrease of systolic blood pressure by 30 +/- 16 mm Hg, but resolved with appropriate treatment. Conclusions. TCAB is possible in cadavers using computer-enhanced telemanipulation technology. The transabdominal approach is a promising access for less invasive cardiac surgery. (C) 1999 by The Society of Thoracic Surgeons.

关键词：血压/生理学冠状动脉分流术/仪器和设备内窥镜内窥镜检查胸廓内动脉-冠状动脉吻合术/仪器和设备心肌血管重建术/仪器和设备机器人绵羊猪遥测术/仪器和设备时间因素动物人类

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Coagulofibrinolysis during heparin-coated cardiopulmonary bypass with reduced heparinization

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1252-1256页

作者： Kumano, H Suehiro, S Hattori, K Shibata, T Sasaki, Y Hosono, M Kinoshita, H Osaka City Univ Sch Med Dept Surg 2 Abeno Ku Osaka 5450051 Japan

Background. We examined the safety of reduced systemic heparinization during heparin-coated cardiopulmonary bypass by measuring coagulofibrinolitic indices, including fibrinopeptide A, which directly reflects fibrinogenesis. Methods. Twenty-four patients who had elective cardiac operations were perfused using a circuit coated with covalently bonded heparin. Twelve patients received 300 U/kg of heparin and the remaining 12 patients received 150 U/kg. Blood was obtained for the measurement of thrombin-antithrombin III complexes, fibrinopeptide A, plasmin-alpha 2 plasmin inhibitor complexes, and D-dimer preoperatively;after heparin administration;10, 60, and 90 minutes after the start of bypass;after protamine administration;and 1, 3, 6, 12, and 24 hours after the end of bypass. Results. Preoperative, intraoperative, and postoperative variables including postoperative bleeding were not significantly different between the two groups. Further, there were no complications in either group. No significant differences between the two groups were noted for any hematologic index at any time point. Conclusions. Reduced systemic heparinization combined with a heparin-coated cardiopulmonary bypass circuit is biochemically and clinically safe but does not reduce postoperative bleeding. (C) 1999 by The Society of Thoracic Surgeons.

关键词：抗纤维蛋白溶解药/代谢抗纤维蛋白溶酶抗凝血酶Ⅲ/代谢心肺转流术/仪器和设备包被物质生物相容性冠状动脉分流术/仪器和设备剂量效应关系药物纤维蛋白纤维蛋白原降解物/代谢纤维蛋白溶解/药物作用纤维蛋白溶解/生理学纤维蛋白肽A/代谢肝素/投药和剂量肽水解酶类/代谢纤溶酶/代谢手术后并发症/血液手术后并发症/诊断手术后出血/血液手术后出血/化学诱导成年人老年人女(雌)性人类男(雄)性中年人

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Comparison of direct aortic and femoral cannulation for port-access cardiac operations

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1529-1531页

作者： Glower, DD Clements, FM Debruijn, NP Staford-Smith, M Davis, RD Landolfo, KP Smith, PK Duke Univ Med Ctr Dept Surg Durham NC 27710 USA Duke Univ Med Ctr Dept Anesthesia Durham NC 27710 USA

Background. Differences in outcome after direct aortic cannulation (AORT) in the chest versus standard femoral arterial cannulation (FEM) have not been defined for minimally invasive cardiac operations utilizing the port-access approach. Methods. A retrospective study was performed of 165 patients undergoing port-access cardiac mitral valve operation (n = 126) or coronary artery bypass grafting (n = 39). In 113 patients, FEM was used, while in 52 patients, AORT was accomplished through a port in the first intercostal space. Results. AORT eliminated endoaortic balloon clamp migration (0/36 [0%] vs 17/95 [18%]), and groin wound or femoral arterial complications (0/52 [0%] vs 11/113 [10%]) without changing procedure times (363 +/- 55 vs 355 +/- 70 minutes). Complications attributable to AORT were injury to the right internal mammary artery and aortic cannulation site bleeding in 1 patient each. Conclusions. Direct aortic cannulation is technically easy, allows use of an endoaortic clamp, and avoids aorto-iliac arterial disease, the groin incision, and possible femoral arterial injury associated with femoral arterial cannulation. Direct arterial cannulation should expand the pool of patients eligible for port-access operation, and may become the standard for port-access procedures. (C) 1999 by The Society of Thoracic Surgeons.

关键词：主动脉胸导管插入术/仪器和设备冠状动脉分流术/仪器和设备设备安全性股动脉心脏瓣膜疾病/外科学心脏瓣膜假体植入/仪器和设备二尖瓣/外科学穿刺术/仪器和设备外科手术微创性/仪器和设备治疗结果成年人女(雌)性人类男(雄)性中年人

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Thoracoscopic mammary artery mobilization in redo minimally invasive coronary bypass operations

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1540-1541页

作者： Wolf, RK Miyaji, K Flege, JB Christ Hosp Dept Cardiac Surg Cincinnati OH 45219 USA Jewish Hosp Cincinnati Div Cardiac Surg Cincinnati OH USA

Background. It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (FI MIDCAB) situation, presumably because adhesions from the previous coronary artery bypass grafting operation may preclude a thoracoscopic approach. However, there are advantages to thoracoscopic ITA mobilization in MIDCAB that could also be realized in the redo situation. Methods. In 200 MIDCAB procedures over the last 3 and a half years, 11 patients, ages 49-83 (mean 69), were identified as having undergone an attempted ITA mobilization in a redo situation. Results. Thoracoscopic ITA mobilization was successful in 9 out of 11 patients (81%). One patient had complete pleural symphysis precluding this approach, and 1 patient had poor mammary now after harvest and this conduit was not used. Both failures were in female octogenarians. Conclusions. To realize the advantages of a tharacoscopic ITA mobilization MIDCAB, both right and left thoracoscopic ITA mobiIization can safely be performed in the redo situation. Thoracic adhesions precluding a thoracoscopic approach were encountered in only 1 of 11 redo coronary artery bypass grafting patients. (C) 1999 by The Society of Thoracic Surgeons.

关键词：冠状动脉分流术/仪器和设备内窥镜检查移植物闭塞血管心肌血管重建术/仪器和设备再手术外科器械胸腔镜老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Totally endoscopic myocardial revascularization: An experimental study

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ANNALS OF THORACIC SURGERY 1999年第4期68卷 1552-1554页

作者： Vlassov, GP Travine, NO Deyneka, KS Ermolov, AS Belinskiy, MB Klimovskiy, SD Zhuravlev, IV Sclifosovsky Sci Emergency Ctr Moscow Russia

Background. The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. Methods and Results. The right gastroepiploic artery was harvested endoscopically through three troacars in 46 human cadavers. Then, a 5-cm hole was made in the diaphragm to expose the right coronary artery. With the help of two vacuum pods, we fixed a site of the right coronary artery and made a right gastroepiploic artery-right coronary artery anastomosis. In 20 cases, continuous Prolene suture was used, and in 26 experiments, we applied a sutureless technique. Twenty-three anastomosis were patent. Conclusions. Despite the low patency rate, the transabdominal approach of totally endoscopic bypass grafting is promising and demands further investigation. (C) 1999 by The Society of Thoracic Surgeons.

关键词：吻合术外科/仪器和设备动脉/移植冠状动脉分流术/仪器和设备内窥镜内窥镜检查可行性研究外科器械人类

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Prevalence of aortocoronary graft marker use and the factors affecting this decision

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JOURNAL OF CARDIAC SURGERY 1998年第3期13卷 194-199页

作者： Eisenhauer, MD Wicks, AB Olson, JP Heric, B Brooke Army Med Ctr Serv Cardiol Ft Sam Houston TX 78234 USA

Background: Despite quantifiable evidence that aortocoronary graft marker (ACGM) insertion is associated with a beneficial impact at postoperative angiography, the choice whether or not to insert them at the time of bypass surgery remains optional. Methods: A onetime anonymous membership survey of the Society of Thoracic Surgeons was used to determine the prevalence of ACGM use and obtain demographic data regarding (1) the type of ACGM inserted, (2) reasons influencing the decision as to whether or not to use ACGMs, and (3) the occurrence of possible related complications. Results: Thirty-nine percent (1,405 of 3,558) and 37% (198 of 531) were returned from within and outside the Unites States, respectively. Sixty percent of US respondents routinely insert ACGMs in the majority of their individual cases. The most frequent reason to not insert ACGMs was a "lack of perceived benefit." Conclusions: The majority of respondents practicing within the United States routinely insert ACGMs at the time of surgery. As no complication directly attributable to the use of graft markers has been reported, further study is warranted to determine the actual complication rate, although it is expected to be low.

关键词：人工血管冠状血管造影术冠状动脉分流术/仪器和设备冠状动脉分流术/统计学和数值数据冠心病/放射摄影术冠心病/外科学决策患病率问卷调查登记/统计学和数值数据回顾性研究学会医学/统计学和数值数据美国人类

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