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右侧微创直接冠状动脉绕道:临床经验和前景

Florian Hecker¹, Mascha von Zeppelin¹, Arnaud Van Linden¹

¹Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, 60598 Frankfurt, Germany.

Medicina (Kaunas, Lithuania)

|May 27, 2023

概括

使用右侧内胸动脉 (RITA) 到右冠状动脉 (RCA) 的右侧微创直接冠状动脉绕道移植 (r-MIDCAB) 对复杂病例是安全有效的. 中期结果显示,在具有挑战性冠状动脉疾病的患者中,心肌痛自由度高.

科学领域:

心血管外科心血管外科
最少侵入性心脏外科手术
冠状动脉疾病的治疗方法

背景情况:

最少侵入性直接冠状动脉旁路移植 (MIDCAB) 是治疗左冠状动脉疾病的标准.
使用右侧内胸动脉 (RITA) 到右冠状动脉 (RCA) 的右侧MIDCAB (r-MIDCAB) 较少建立.
对复杂的右冠状动脉疾病使用r-MIDCAB的经验有限.

研究的目的:

介绍r-MIDCAB在患有复杂冠状动脉疾病的患者手术经验.
为了评估r-MIDCAB的安全性和有效性,使用RITA绕过RCA.
评估接受r-MIDCAB的患者的中期结果.

主要方法:

在2019年10月至2023年1月期间接受r-MIDCAB (RITA to RCA) 的11名患者的回顾性分析.
通过右前部小胸切除术而没有心肺旁路术的最小侵入性技术.
包括标准:复杂的右冠状动脉狭窄 (n=7) 和异常的右冠状动脉 (ARCA;n=4).

主要成果:

在所有11名患者中取得成功的r-MIDCAB,而没有转换为胸腔切除术.
没有术后并发症:没有需要重新探索的出血,心肌梗塞,中风或死亡.
随访24个月的中位数显示,所有患者都活着,90%的患者无心痛.
在所有患者中,RITA-RCA绕道仍然完全有效;在2名患者中,重复复血管化与绕道无关.

结论:

右侧MIDCAB (r-MIDCAB) 是一种安全有效的重血管化策略,适用于患有复杂的RCA狭窄或ARCA的患者.
中期结果显示,症状缓解和移植通透率高.
需要对更大的队列进行进一步的研究,以确定r-MIDCAB作为孤立复杂RCA疾病和ARCA的标准重血管化选择.

关键词:

异常的右冠状动脉 (ARCA)冠状动脉绕道移植 (CABG) 冠状动脉绕道移植微创心脏手术是最少的入侵性心脏手术.最少入侵的直接冠状动脉旁路移植 (MIDCAB)

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