Hello! I am Liu Jian
Today is the 566th issue that Jian Ge said to accompany you
Everyone has heard of hybrid rice, which improves quality and yield through the hybridization of different rice species. But you know what? The treatment of coronary heart disease also has a hybridization approach, called coronary hybrid surgery.
In this issue, we will introduce this surgical method.
Traditional coronary interventional surgery and surgery
Traditional treatment of coronary heart disease can be summarized as a "troika": drug treatment, interventional surgery and surgery. These three treatment methods are widely known by the people, drugs are the cornerstone of the treatment of coronary heart disease, if the coronary artery lesions are relatively serious, it is necessary to intervene in surgery or surgery to deal with, but the two surgical methods have advantages and disadvantages.
Relatively speaking, the advantages of interventional surgery are local anesthesia operation, less trauma, only need to puncture the needle on the artery at the base of the wrist or thigh, interventional surgery is a minimally invasive operation, the patient recovery is faster after surgery, there are relatively few complications, but sometimes limited by the complexity of coronary artery lesions, and the requirements for drugs (especially antiplatelet drugs) are higher.
Surgery mainly includes bypass surgery, the treatment of multiple lesions has advantages, generally can be fully resolved at one time, especially the bypass of the left internal mammary artery to the anterior descending branch, which is currently recognized as the best treatment plan for the treatment of pre-descending branch lesions, but surgical surgery requires open chest, general anesthesia, the operation time is longer, the relative trauma is greater, the hospitalization time and recovery time are relatively long, and some surgeries also need to rely on the support of extracorporeal circulation.
Innovative coronary hybrid surgery
So is there a treatment that combines the advantages of intervention and surgery while avoiding their shortcomings?
In 1996, the British scholar Angelini proposed the coronary treatment plan of "Hybrid Surgery", and Angelini's team reported the treatment results of 6 cases of multiple lesions of coronary heart disease in Lancet, and the researchers gave them percutaneous interventional stent implantation treatment first, and then used a minimally invasive incision to perform non-extracorporeal bypass surgery for left anterior descending branch lesion. However, due to the difficulty of minimally invasive surgical procedures, this "hybrid surgery" treatment method was not widely promoted at that time.
With the development and progress of medical technology, the current hybrid surgical method of coronary heart disease has a mature and stable model, for some patients with multiple lesions, cardiac surgeons can complete the acquisition of the left internal mammary artery and the bypass surgery of the anterior descending branch under an incision of only 5 to 6 cm long, through the gap between the ribs; subsequently, at the right time, the cardiologist implants a stent in the coronary vein of other lesions.
Simply put, coronary hybrid surgery is a combination of minimally invasive small incision coronary artery bypass surgery (surgical technology) and percutaneous coronary intervention (internal medicine technology) to treat patients with coronary heart disease with multiple vascular lesions, so that the combination of internal and surgical and dual swords can fully solve the patient's coronary problem.
Hybrid treatment methods have brought new treatment hopes to some patients with high risk of traditional surgery, complex coronary artery lesions and difficult interventional operations. In the process of hybrid surgery, surgery does not need to split the sternum, does not rely on extracorporeal circulation, the operation time is relatively short, can fully solve the multi-branch coronary artery lesions, and the overall drug need is small, the disease recovery is fast, especially for some elderly or young patients, who benefit more, do not need long-term care, and can soon return to family life, and even return to work.
At present, coronary artery hybridization surgery is divided into one-stop and sub-station surgery. One-stop hybrid surgery refers to the simultaneous completion of surgical bypass and internal stent surgery, the patient does not need to go through two anesthesia, greatly reducing the risk of surgery and postoperative complications, but the requirements for the surgeon and the operating room are high, and need to be carried out in a special hybrid operating room. However, the sub-station hybridization procedure usually completes the surgical bypass surgery first, and then performs stent surgery at the right time a few days later, which is easier to achieve and has a lower risk of postoperative bleeding.
Brother Jian said
Coronary hybridization refers to the simultaneous or substation interventional treatment and minimally invasive coronary artery bypass surgery for patients with coronary heart disease.
Coronary hybrid surgery is an innovative treatment method that abandons shortcomings and complements each other's advantages, learns from each other's strengths and simplifies complexities, and will become the "fourth carriage" of coronary heart disease treatment, bringing more suitable treatment options to patients.
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"On the Heart" - Medicine, Health and Lifestyle of the Heart
Works by Professor Liu Jian