Medical selection criteria: choose to left anterior descending artery oxford cafe karlsruhe single-vessel disease, interventional treatment or intervention can not be treatment failure, no other vascular lesions or lesions less than 50%.
After the success of general anesthesia, the patient supine, the skin incision from the lower sternal angle about 3 cm from the xiphoid. Conventional median transverse sawing the breastbone and left half of the sternum from the xiphoid to the second intercostal space. With internal mammary artery sternal retractor retractor and raise the left half of the sternum, electric knife free parietal pleura, keeping intact the left pleural cavity, exposed and free the pedicle LIMA within reach of the first rib between levels; routine after cut off under the pericardium, the left internal mammary artery heparin, vascular pedicle surface spray 1% papaverine solution to prevent oxford cafe karlsruhe vasospasm. Suspension and fixed pericardium, pediatric oxford cafe karlsruhe sternal retractor distraction sternum, oxford cafe karlsruhe using the off-pump cardiac fixator target vessel, cut the target vessel, intracoronary shunt placement, blowing mist (CO 2 mixed with saline aerosol) Auxiliary exposed stoma, 8-0prolene line to complete the left internal mammary artery and distal left anterior oxford cafe karlsruhe descending artery cut side continuous suture. The exact bleeding, pericardial and mediastinal drainage after placement closed chest tube.
By segment being small incision under the sternum coronary bypass surgery compared with conventional coronary artery bypass grafting median thoracotomy, the lower sternum incision coronary artery bypass surgery oxford cafe karlsruhe has the following advantages [5, 6]: (1) In the first incision Second intercostal space below the sternum and thoracic small damage the integrity, preservation of the integrity of the segment oxford cafe karlsruhe sternum conducive fixed sternum. (2) After the sternum and sternal wound is small, avoiding the first rib fractures and brachial plexus injury, surgical trauma. (3) the surgical incision is small and low skin incision location conducive beautiful. (4) lower sternum being small incision coronary artery bypass surgery can reduce the impact on lung function is still disagreement: oxford cafe karlsruhe Bauer et al [7] studies suggest that the impact of the two surgical methods no significant differences in lung function, and Solange, oxford cafe karlsruhe etc. [8] Recent studies suggest that segment being small incision under the sternum coronary bypass surgery can reduce the impact of surgery on pulmonary function.
After being lower sternum small incision coronary artery bypass surgery in some ways is better than other current methods of minimally invasive CABG. Main features: (1) If surgery is required, it is easy to expand the conventional median thoracotomy incision up to deal with intraoperative diagnosis and preoperative diagnosis is inconsistent, to be completed over the same period aneurysm resection or (and) other open heart cardiac surgery, such as heart valve surgery, cardiac myxoma removal, to reduce the risk of minimally invasive coronary artery bypass surgery; (2) If the internal mammary artery blood flow enough or internal mammary artery oxford cafe karlsruhe injury, could be replaced by a vein or other vascular bypass graft material, without separate other chest incision, be able to successfully complete the surgery; (3) the free mammary artery pedicle is relatively easy, but full, not easy to damage. Get mammary oxford cafe karlsruhe artery can get enough length [9]. Because from a conventional, familiar perspective to the free internal mammary artery, is different from the small incision through the chest wall under direct oxford cafe karlsruhe vision internal mammary artery as a free, requires more re-exploration, adaptation and habit, not need, like free use thoracoscopy internal mammary artery that requires special equipment and special training to master. (4) lower sternum being small incision pain patients to light in the anterolateral chest incision [9].
Minimally invasive coronary artery bypass surgery technical points oxford cafe karlsruhe that the internal mammary artery pedicle free and reveal the target vessel coronary anastomosis is completed. Lower segment incision through the sternum, it can not be too difficult to free internal oxford cafe karlsruhe mammary artery segment reached the level of the first rib. Initially, the sternal retractor try not to open a large, free to be upward beyond the second intercostal space, and then open a large retractor appropriate to avoid retractor for internal mammary artery traction injury. In free process must be noted: (1) on the free mammary artery segment must reach the level of the first rib, to avoid postoperative steal and make sufficient length. (2) free to preserve intact the left internal mammary artery oxford cafe karlsruhe when the pleural cavity, oxford cafe karlsruhe reduce the incidence of postoperative complications. But the fundamental security should be given priority in terms of surgery, so it should have a good surgical indications.
. 1 Holzhey DM, Cornely JP, Rastan AJ, et al Review of a 13-year single-center experience with minimally invasive direct coronary artery bypass as the primary surgical treatment of coronary artery disease [J] Heart Surg Forum 2012;.. 15 (2): E61-68.
3 Kofidis T, Emmert MY, Paeschke HG, et al Long-term follow-up after minimal invasive direct coronary artery bypass grafting oxford cafe karlsruhe procedure:... A multi-factorial retrospective oxford cafe karlsruhe analysis at 1000 patient-years [J] Interact Cardiovasc Thorac Surg 2009 ; 9 (6): 990-994.
. 4 Calafiore AM, Giammarco GD, Teodori G, et al Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass [J] Ann Thorac Surg, 1996; 61 (6):. 1658-1665.
7 Bauer M, Pasic M, Ewert R, et al Ministernotomy versus complete sternotomy for coronary bypass operations: no difference in postoperative pulmonary function [J] J Thorac Cardiovasc Surg 2001; 121 (4):... 702-707.
. 9 Trehan N, Malhotra R, Mishra Y, et al Comparison oxford cafe karlsruhe of ministernotomy with minithoracotomy oxford cafe karlsruhe regarding postoperative pain and internal mammary artery characteristics oxford cafe karlsruhe [J] Heart Surg Forum 2000; 3 (4):.. 300-6.
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