ObjectiveTo assess the immediate results of myocardial revascularization surgery without extracorporeal circulation in a group of patients over 75 years of age. December 2003, 193 (121 men and 72 women) Methods From January 2001 to ConclusionThe surgery adopted for myocardial revascularization was associated with a low mortality rate, a low complication index, and a short length of stay at the hospital. Keywords elderly, myocardial revascularization surgery, extracorporeal circulationThe increase in the elderly population in Brazil in recent years has led to a greater number of patients over the age of 70 years requiring myocardial revascularization surgery. However, over the years, advanced age has been considered a risk factor for morbidity and mortality in coronary artery surgeries 1,2 . The recent advances in myocardial revascularization surgeries without extracorporeal circulation, the technique recommended by Buffolo et al 3 and Benetti 4 at the beginning of the 1980s, has aroused interest in this type of surgery, especially in high-risk patients [5][6][7] .We retrospectively analyzed the immediate results of the myocardial revascularization surgery without extracorporeal circulation in patients over the age of 75 years.
Objective: To analyze the hospital outcomes of patients, with chronic renal insufficiency on hemodialysis, submitted to OPCAB.Method: Fifty-one patients with chronic renal insufficiency were submitted to OPCAB. Hemodialysis was performed on the day before and the day after the operation. Myocardial revascularization was performed using LIMA's suture and suction stabilization.Results: Fifty-one patients, with an average age of 61.28 ± 11.09 years, were analyzed. Thirty-one patients (58.8%) were female. The predominant functional class was IV in 21 (41.1%) of the patients. The left ventricle ejection fraction was dire in 21 (41.1%) patients. The mean EUROSCORE of this series was 7.65 ± 3.83 and the mean number of distal anastomosis was 3.1 ± 0.78 per patient. The average time of mechanical ventilation was 3.78 ± 4.35 hours and the mean ICU stay was 41.9 ± 13.8 hours, while the average hospitalization was 6.5 ± 1.31 days. In respect to complications, 9 (17.6%) of the patients developed atrial fibrillation and one (1.9%) patient presented with a case of ischemic stroke but had a good recovery during hospitalization. There were no deaths in this series.Conclusion: Chronic renal patients submitted to hemodialysis were always a high risk population for myocardium revascularization. In this series, the absence of extracorporeal circulation appeared to be safe and efficient in this special subgroup of patients. The operations were performed with low indices of complications, absence of deaths and relatively low stays in the ICU and in hospital.Descriptors: Myocardial revascularization. Renal insufficiency, chronic. Renal dialysis. MILANI, R ET AL -OPCAB in patients on hemodialysisBraz J Cardiovasc Surg 2007; 22(1): 104-110
RBCCV 44205-762Revascularização do miocárdio sem circulação extracorpórea com enxertos arteriais: análise de 300 casos Off-pump coronary artery bypass grafting with arterial grafts: analysis of 300 cases Abstract Objective: The present study reviews our immediate results of off-pump coronary artery bypass grafting using only arterial grafts.Method: Between June 2000 and December 2004, 300 patients were submitted to off-pump myocardial revascularization using only arterial grafts. The left internal mammary artery was the first-choice graft, followed by the radial artery and the right mammary artery.Results: The ages of the patients ranged from 33 to 77 years, with 234 male and 66 female. In respect to risk factors for coronary disease, 77% had hypertension, 66% had a history of smoking, 53% had high levels of cholesterol and 21% had diabetes. Eighty-four patients (28%) had a history of myocardial infarction and 77 (25.6%) were using endovenous nitroglycerin in the preoperative period. The ejection fraction was less than 30% in 77 (25.6%) patients. A total of 189 patients had multi-vessel disease. The EuroSCORE ranged from 0 to 12 points with an expected mortality rate of 3.7%. The total numbers of distal anastomoses were 838, with a mean of 2.79 ± 0.97 anastomoses per patient. There were six deaths in this series, one caused by renal failure, one caused by metabolic disorders, two caused by mediastinitis, one caused by pneumonia and one caused by bleeding. Diabetes was the only factor associated with mortality.Conclusion: The use of arterial grafts in off-pump myocardial revascularization did not increase the immediate morbidity or mortality in this series. The results were similar to the results predicted by the EuroSCORE. The use of only arterial grafts in diabetic patients must be carefully evaluated. Descriptors
Análise dos resultados imediatos de estudo comparativo entre anastomose mecânica aorto-safena versus convencionalAnalysis of the immediate outcomes of a comparative randomized study between aortosaphenous mechanical anastomosis versus conventional anastomosis Conclusion: The present study showed a statistically significant superiority for mechanical anastomosis of the saphenous vein with the aorta when evaluated the blood free flow and the time to perform the anastomosis. In relation 311MILANI, R ET AL -Analysis of the immediate outcomes of a comparative randomized study between aorto-saphenous mechanical anastomosis versus conventional anastomosis Bras Cir Cardiovasc 2007; 22(3): 310-316 Rev
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