机器人全内窥镜心肌桥体外剥离术:早期经验和中期疗效。

Sarah Nisivaco, John Blair, Amit Patel, Hiroto Kitahara, Tess Allan, Brooke Patel, Charocka Coleman, Husam H Balkhy
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引用次数: 0

摘要

目的:心肌桥接(MB)是指冠状动脉(通常是左前降支(LAD))在心肌内的走向。对于药物治疗无效的无症状患者,手术开胸可以通过改善冠状动脉血流来缓解症状。我们介绍了一系列接受机器人全内镜下心脏跳动 MB 开顶术的患者:在2017年1月至2023年10月期间,共有34名药物治疗失败的LAD-MB患者接受了机器人全内镜下泵外解顶术。患者接受了多学科团队的评估,并接受了诱导性冠状动脉造影术以确认血流动力学意义。我们回顾了围手术期的结果,并联系患者进行中期随访,包括完成改良的西雅图心绞痛问卷(SAQ):平均年龄为 48 ± 8 岁,女性患者占 56%。一名患者曾通过胸骨切开术进行室间隔肌肉切除术。所有患者在术前冠状动脉造影检查中均发现多巴酚丁胺 Pd/Pa 明显降低。一名患者患有心房颤动,同时接受了左心房阑尾结扎消融术。平均手术时间为 140 ± 69 分钟。所有手术均完全在内镜下完成,无术中转换。MB 平均长度为 4.5 ± 1.4 厘米,平均深度为 1.6 ± 0.9 厘米。76%的患者在手术室内拔除了气管。重症监护室和医院的平均住院时间分别为 0.97 ± 0.58 天和 1.73 ± 1.1 天。无死亡或中风病例。术后有一次因出血而收回手术。在中期随访(19±14个月)中,28名患者完成了SAQ;86%的患者表示活动时的心绞痛比手术前 "少得多",93%的患者表示手术后没有服用抗心绞痛药物:结论:对于血流动力学意义重大且药物治疗无效的 LAD-MB 患者,机器人心脏搏动解刨术是可行的,且效果良好。值得进一步研究。
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Robotic Totally Endoscopic Off-Pump Unroofing of Myocardial Bridge: Early Experience and Midterm Outcomes.

Objective: Myocardial bridging (MB) occurs when a coronary artery, commonly the left anterior descending (LAD), has an intramyocardial course. In symptomatic patients who fail medical therapy, surgical unroofing can provide symptomatic relief by improving coronary blood flow. We present a series of patients undergoing robotic totally endoscopic beating-heart MB unroofing.

Methods: There were 34 patients with an LAD-MB who failed medical therapy and underwent robotic totally endoscopic, off-pump unroofing between January 2017 and October 2023. Patients were evaluated by a multidisciplinary team and underwent provocative coronary angiography to confirm hemodynamic significance. We reviewed perioperative outcomes and contacted patients for midterm follow-up, including completion of a modified Seattle Angina Questionnaire (SAQ).

Results: The mean age was 48 ± 8 years, and 56% were female patients. One patient had prior septal myectomy via sternotomy. All patients had significant dobutamine Pd/Pa reduction on preoperative coronary angiography. One patient had atrial fibrillation and underwent concomitant ablation with left atrial appendage ligation. The mean procedure time was 140 ± 69 min. All were completed totally endoscopically off-pump without intraoperative conversions. The mean MB length was 4.5 ± 1.4 cm, and the mean depth was 1.6 ± 0.9 cm. Of the patients, 76% were extubated in the operating room. The mean intensive care unit and hospital length of stay were 0.97 ± 0.58 and 1.73 ± 1.1 days, respectively. There were no mortalities or strokes. There was 1 postoperative take-back for bleeding. At midterm follow-up (19 ± 14 months), 28 patients completed the SAQ; 86% reported "much less angina" during activity compared with before surgery, and 93% reported taking no antianginal medication since surgery.

Conclusions: In appropriate patients with hemodynamically significant LAD-MB who fail medical therapy, robotic beating-heart unroofing is possible with good outcomes. Further studies are warranted.

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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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