微创冠脉搭桥的优点
The benefits of minimally invasive CABG over traditional surgery include:
- 更少的痛苦
- 降低感染和其他手术并发症的风险
- 降低中风和心律失常的风险
- 减少失血量，减少输血需求
- 手术时间短，麻醉时间短
- 缩短住院时间
- 更快的恢复时间，更快地恢复正常活动
- 美观效果更好(疤痕更小)
谁可能从微创冠脉搭桥中获益
Most candidates for coronary artery bypass grafting can benefit from this minimally invasive option. That's especially true for patients at higher risk from open-heart surgery because of age, 虚弱或其他健康状况，如肥胖, diabetes and chronic obstructive pulmonary disease (COPD) – or because they are immunocompromised.
然而，这种手术并不适用于所有的搭桥病人. 既往胸部或肺部手术, 胸部放射治疗, or intrapleural chemotherapy can leave adhesions and scar tissue that can complicate the ability to access the heart. 但这些并不完全排除使用CABG. We make our decisions on a case-by-case basis after a full evaluation.
微创冠脉搭桥的评价
Your doctor will decide whether you're a candidate for minimally invasive CABG based on a few factors, 包括:
- 心脏病症状的出现和严重程度
- 冠状动脉阻塞的严重程度和部位
- 你对其他治疗的反应
- 你的生活质量
- 你还有其他健康问题吗
The evaluation process is very similar for minimally invasive CABG and the traditional open-heart bypass surgery. Your doctor will perform a physical exam focused on your cardiovascular system. 将进行测试以找出哪些动脉堵塞了, 堵塞的范围和位置, 以及你的心脏是否受损. 这些测试包括:
- 心电图(心电图). This is a simple test that detects and records your heart's electrical activity. 它被用来帮助检测心脏问题并确定其根源.
- 冠状动脉造影. 一根导管, 一个瘦, 挠性管, is inserted into a blood vessel (usually in the groin area) and threaded through to the heart. A dye is injected through the catheter and special X-rays track the blood flow through your heart and arteries. The scan shows where the blockages are and whether your blood vessels are healthy and large enough to support a bypass.
- 左心导管. 这种检查类似于冠状动脉造影，可以代替. 一根导管 is threaded through blood vessels to the heart and arteries, and dye is injected. 由此产生的x射线图像突出了动脉中的血液流动, allowing the doctor to locate blockages and determine whether your arteries are in good enough shape to support a bypass.
- 经胸超声心动图(TTE). 在非侵入性超声扫描期间, the transducer (the device emitting sound waves to produce images of your heart) is held against your chest. The test provides information about how well your heart valves and chambers are working and how blood is moving through.
- 动脉映射. An ultrasound scan is done to obtain detailed pictures of radial arteries (in the forearm) that may be used as bypass grafts. The graft vessels are obtained through an endoscopic technique that requires only a tiny incision at the wrist.
微创冠脉搭桥手术
The operation for minimally invasive CABG takes from two and a half to three and a half hours. 你处于全身麻醉状态(完全睡着了). 治疗你的团队包括你的心胸外科十大赌博平台排行榜, 麻醉师, 其他十大赌博平台排行榜和护士. 如果你的十大赌博平台排行榜决定你需要心肺机的支持, a perfusionist (a heart-lung bypass machine specialist) will also be present.
The surgeon will make a 2-to 2½-inch incision between the ribs on the left side of the chest. Specialized surgical instruments are then inserted through the incision, as well as an endoscope – a tube with a camera attached – which allows the doctor to see inside your chest. 该区域的肌肉被推开. The surgeon finds and prepares an artery on the chest wall and then attaches it to the affected coronary artery, 就在堵塞之后. 如果有不止一条动脉堵塞，这个过程就会重复. Once all the bypasses are connected, the instruments are withdrawn, and the incision is closed.
病人 with weak or dilated hearts may need to be on a heart-lung bypass machine during the surgery to support their heart. However, the heart is not stopped, as it is during a traditional open-heart CABG procedure. Your doctor will let you know ahead of time whether this is necessary.
微创冠脉搭桥术后的恢复
手术后的18到24小时, 你在心脏重症监护病房, 在那里我们可以密切监测你的情况. 然后你会被转移到一个普通的病房再呆一天左右. 大多数病人术后3天出院. 你会收到关于如何在家照顾自己的指导.
One of the biggest advantages of minimally invasive CABG is the short recovery time. Most patients are free to move as they wish – they can even drive as soon as they leave the hospital. 大多数人在10到15天内就能恢复正常的身体活动, 而传统CABG的恢复需要三到四个月.
与传统的冠脉搭桥一样，患者也能获得良好的效果. 许多人多年来都没有症状, though clogs can develop in the grafted arteries or in arteries that weren't previously blocked. 生活方式的改变和药物治疗可以帮助预防新的堵塞.
微创冠脉搭桥的风险
The minimally invasive procedure reduces the likelihood of some of the most common complications of traditional CABG. 因为切口更小，没有骨头被切开, 在微创冠脉搭桥期间或之后出血的风险较低. 风险更小 中风 or 心房纤颤 因为心脏没有停止跳动. 此外，较小的切口减少了感染的机会.
The less common risks are about the same for the two approaches to CABG. 这些可能性包括肺炎或呼吸问题, 胰腺炎, 肾功能衰竭和移植物衰竭.
