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冠状动脉旁路移植术中主动脉近端吻合装置的临床应用 被引量:3

Clinical Application of Aortic Proximal Anastomosis Device in Coronary Artery Bypass Grafting
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摘要 目的评价主动脉近端吻合装置在冠状动脉旁路移植术(CABG)中应用的初步疗效,进一步论证其安全性及可行性。方法自2006年1月至2007年5月我们共对50例冠心病患者在施行CABG主动脉近端吻合时使用吻合装置[Novare Enclose Ⅱ系统(Novare Surgical System,Cupertino,CA)]吻合。术前合并高血压病28例、糖尿病17例、陈旧性心肌梗死18例、陈旧性脑梗死15例。其中行体外循环CABG(CABG)16例,非体外循环CABG(OPCAB)34例。共使用主动脉近端吻合装置吻合175次(3.2±1.37),其中静脉吻合152次、游离左乳内动脉(LIMA)12次、桡动脉11次。结果术中移植血管经即时血流仪测量血流满意。未出现与近端吻合装置有关的并发症,无院内死亡。术后2例因胸腔引流量偏多而二次开胸止血,2例因呼吸功能不全行气管切开,1例因糖尿病、肾病、肾功能不全而行血液透析,5例患者经过积极治疗,治愈出院。术后未出现脑部相关并发症,未出现严重的心脏事件。术后1-3个月对50例患者通过电话以及信件随访,生存率为100%,心脏相关事件豁免率100%。结论主动脉近端吻合装置初步应用临床安全、有效,但其中、远期效果尚需进一步观察。 Objective To evaluate the preliminary the therapeutic effect of the aortic proximal anastomosis device applied in coronary artery bypass grafting (CABG), and further to assess its safety and feasibility. Methods From January 2006 to May 2007, 50 patients underwent CABG were received the aortic proximal anastomosis device [Novare Enclose Ⅱ device (Novare Surgical System, Cupertino, CA)], in which 16 were underwent in on-pump CABGand 34 in off-pumpCABG(OPCAB). The age was 56.2±18.7years(from 55 to 80 years), and there were 38 males and 12 females. Preoperative complications included hypertension in 28 cases, diabetes in 17 cases, old myocardial infarction 18 cases and old cerebral infarction in 15 cases. A total of 175 proximal anastomoses were performed (3.2±1.3), among which there were 152 vein, 12 free left internal mammary artery (LIMA) and 11 radial artery anastomoses. Results Intraoperative transient graft flow meter revealed a satisfactory blood flow. There were no device related complications, and there was no hospital death. 2 cases needed chest re-exploration for hemostasis, 2 cases needed tracheostomy for respiratory insufficiency, and 1 case needed hematodialysis for renal inadequacy caused by diabetic nephropathy. All this 5 patients got recovered and discharged after active treatment. There were no cerebra related complications and no severe cardiac accidents. Follow-up 1 to 3 months after surgery via telephone or letter revealed a 100% survival rate and a 100% exemption rate of cardiac accident. Conclusion Preliminary clinical application of the Novare Enclose Ⅱ device is safe and efficient, but its middle and long-term effect remains to be further observed.
出处 《中国胸心血管外科临床杂志》 CAS 2008年第4期255-259,共5页 Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词 冠状动脉旁路移植术 近端吻合装置 疗效 Coronary artery bypass grafting Proximal anastomosis device Therapeutic effect
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参考文献12

  • 1Taggart DP, Westaby S. Neurological and cognitive disorders alters coronary artery bypass grafting. Curr Opin Cardiol, 2001, 16(5): 271 276.
  • 2Kapetanakis EI, Stamou SC, Dullum MK, et al. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study. Ann Thorac Surg, 2004, 78(5): 1564 1571.
  • 3Aranki SF, Shekar PS, Ehsan A, et al. Evaluationg of the enclose proximal anastomosis device in coronary artery bypass grafting. Ann Thorac Surg, 2005, 80(3) : 1091-1095.
  • 4Blauth CI, Cosgrove DM, Webb BW, et al. Atheroembolism from the ascending aorta: An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg, 1992, 103(6): 1104-1112.
  • 5Barzilai B, Marshall WG, Saffitz JE, et al. Avoidance of embolic complications by ultrasonic characterization of the ascending aorta. Circulation, 1989, 80(3 Pt 1) :I275-I279.
  • 6Chavanon O, Carrier M, Cartier R, et al. Increased incidence of acute ascending aortic dissection with off-pump aorto coronary bypass surgery? Ann Thorac Surg, 2001, 71(1): 117-121.
  • 7Reuthebuch O, Kadner A, Lachat M. et al. Early bypass occlusion after deployment of nitinol connector devices. J Thorac Cardiovasc Surg, 2004, 127(5): 1421-1426.
  • 8Okada K, Sueda T, Orihashi K, et al. Early type a dissection with the aortic connector device. Eur J Cardiothorae Surg, 2004. 25(5): 902-904.
  • 9Akpinar B, Guden M. Sagbas E, et al. Clinical experience with the Novare Enclose n manual proximal anastomotic device during off-pump coronary artery surgery. Eur J Cardiothorac Surg, 2005, 27(6):1070-1073.
  • 10Wolf LG, Abu-Omar Y, Choudhary BP, et al. Gaseous and solid cerebral microembolization during proximal aortic anastomoses in off-pump coronary surgery: the effect of an aortic side-biting clamp and two clampless devices. J Thorac Cardiovasc Surg, 2007, 133(2) : 485-493.

同被引文献31

  • 1薛松,肖明第,胡振雷,袁忠祥,吕志前,叶一舟,施盛.非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病[J].中国微创外科杂志,2004,4(5):363-365. 被引量:13
  • 2姜武,秦巍,郝建潮,武猛.280例冠状动脉旁路移植术临床分析[J].中国心血管病研究,2007,5(6):429-431. 被引量:4
  • 3Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery [J]. Circulation, 2004, 110 : e340-e437.
  • 4Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guide- line update for coronary artery bypass graft surgery [ J ]. Circula- tion.2004.110:340 - 437.
  • 5Dullum MK, Resano FG. Xpose:a new device that provides repro- ducible and easy access for multivessel beating heart bypass grafting [J]. Heart Surg Forum, 2000, 3(2) : 113 -117; discussion 117 -118.
  • 6高华炜,郑哲,胡盛寿,周游.影响冠状动脉旁路移植术手术死亡的危险因素分析[J].中国胸心血管外科临床杂志,2007,14(5):321-325. 被引量:22
  • 7Sfi MP, Ferraz PE, Escobar RR, et al. Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13524 patients from randomized trials. Rev Bras Cir Cardiovasc, 2012,27(4): 631-641.
  • 8Nilsson J, Algotsson L, H6glund P, et al. EuroSCORE predicts intensive care unit stay and costs of open heart surgery. Ann Thorac Surg, 2004, 78(5): 1528-1534.
  • 9Hirose H, Noguchi C, Inaba H, et al. The role of EuroSCORE in patients undergoing off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg, 2010, 10(5 ) : 771-776.
  • 10Wan S, Izzat MB, Lee TW, et al. Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. Ann Thorac Surg, 1999, 68( 1 ): 52-56.

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