OBJECTIVES: Off-pump coronary artery bypass grafting occurrence increases constantly. However transient low cardiac output events occur during this procedure requiring aggressive volume replacement, which may lead to hypervolemia and its complications. METHOD: This study evaluates the safety and efficacy of a hypertonic-hyperoncotic NaCl solution (6% hydroxyethylamide + 7.5% sodium chloride) versus isotonic saline during the creation of anastomosis in the lateral wall of the left ventricle. In each case, 250 ml of solution was administered from coded bags at the start of the grafting procedure. All staff directly connected with the surgical procedure and post-operative management of patients was blinded to the coding. The primary objective was the determination of post-surgery complications. Secondary objectives were the determination of mean arterial blood pressure and central venous pressure during anastomotic grafting. RESULTS: Primary objectives showed no difference between hypertonic versus isotonic saline in post-operatory surgery complication. Significant increases of mean arterial pressure and central venous pressure in the Hypertonic Saline group versus normal saline patients during grafting were observed. CONCLUSION: The use of hypertonic saline during off-pump coronary artery bypass grafting on the lateral posterior wall of the left ventricle led to no complications and improved arterial and central venous pressure, favoring the creation of anastomosis in this wall.
Análise angiográfica tardia dos enxertos empregados na revascularização miocárdica de pacientes com retorno de sintomasCABG late angiographic grafting patency analysis in patients with recurrent symptoms Abstract Objective: Left internal thoracic artery (LITA) grafting has become essential in coronary artery bypass graft procedure (CABG). In order to optimize the use of LITA or other grats, sequential anastomosis has been used. There is no consensus on equivalence between isolated versus sequential grafts. The aim of this study is to compare isolated versus sequential grafts.Methods: From a retrospective patency analysis of the grafts used in 88 symptomatic patients who underwent CABG procedure in our Service was performed through cinecoronariography. Statistical analysis was performed through Student's t test. Each distal anastomosis was considered an independent graft.Results: The mean postoperative period was of 53 + 138 months and mean age was 64 + 11 years. LITA isolated grafts presented patency rate significantly higher than the sequential grafts, respectively 92% (46/50) and 77% (30/39) P = 0.02. However, in injured coronary arteries of > 70%, isolated LITA patency rate was similar to sequential grafts, (95%; 37/39) and (93%; 26/28) respectively; P = 0.37. Mean radial artery patency rate was similar to isolated 71% (5/7) and sequential 90% (19/21) grafts; P = 0. Saphenous veinThis study was carried out at the Paulo Sacramento Hospital. patency rates were similar for isolated 72% (31/43) and sequential 81% (73/90) grafts; P = 0.12. There was no difference between radial artery and saphenous vein patency rates.Conclusion: In symptomatic patients, isolated LITA patency is superior than sequential LITA. However, in coronary injuries of > 70%, the isolated and sequential patency rates are similar. Sequential grafts from radial artery and saphenous vein are similar to their respective isolated grafts. Descriptors: Radial artery. Mammary arteries. Saphenous vein. Coronary disease/surgery. Myocardial revascularization. Resumo Objetivo: A Artéria Torácica Interna Esquerda (ATIE) é o padrão ouro como enxerto na revascularização miocárdica (RM). Para otimizar seu uso, e de outros enxertos, têm sido usadas anastomoses sequenciais. Não há consenso da equivalência dos resultados entre enxertos isolados e sequenciais. O objetivo é comparar a perviabilidade dos enxertos isolados versus sequenciais. 139ROCHA E SILVA, R ET AL -CABG late angiographic grafting patency analysis in patients with recurrent symptoms Bras Cir Cardiovasc 2009; 24(2): 138-142 Rev
Objective: To comparatively analyze minimally invasive procurement of saphenous veins using the MINI-HARVEST ® system and a technique using adapted traditional instruments.Method: From June 1996 to January 1999, 63 patients who were submitted to coronary artery bypass grafting surgery had their saphenous veins resected using minimally invasive techniques. For the first 30 patients of the series, a direct visualization method employing two Langenbeck's retractors was utilized and for the remaining 33 patients the MINI-HARVEST ® technique was used.Results: The mean age of the patients was 61 ± 8.75 years old. Fifty-two patients were male and 11 female. Forty-five patients were diabetics, 45 were either overweight or obese, 25 were smokers and 32 presented histories of myocardial infarction. The mean time to resect the saphenous vein using the Langenbeck's retractors was 34.2 ± 8.14 minutes and using the MINI-HARVEST ® system it was 39.20 ± 9.12 minutes. The lengths of the extracted veins were similar in both groups, varying between 10 and 30 cm. There was one case of superficial dehiscence in the Langenbeck group. With two patients in the MINI-HARVEST ® group and one in the Langenbeck group it was necessary to revert to the traditional method of procurement. The incidence of trans-operative infarction was 4.5 % (three patients) in the Langenbeck group and 3.1% (two patients) in the MINI-HARVEST ® group.Conclusions: We can conclude that the minimally invasive procurement methods of the saphenous vein by direct visualization are effective and safe, both when employing with adapted traditional instruments and when using purposemade retractors. We stress, however, that the MINI-HARVEST ® method does not require an assistant.
SUMMARYDuring coronary artery bypass graft (CABG) surgery, the saphenous vein is sutured through its proximal segment to the aorta. Intimal hyperplasia is one of the possible causes of graft occlusion. Notably, blood turbulence can induce wall shear stress that may also play an important role in this process.OBJECTIVEWe propose a new technique for performing proximal anastomosis to avoid CABG failure.METHODAn 80 kg pig was subjected to open heart surgery. Four stitches were placed in the anterior ascending aorta, which formed a 2 cm by 4 cm patch. This patch was isolated through the application of a tangential clamp that was oriented parallel to the axis of the aorta. After releasing the patch, which was held to the aorta through its cranial end pedicle, the rims were sutured to each other creating a conduit with a length of 4 cm and an internal diameter of 4 mm. The rest of the aortotomy was closed by placing a direct suture between its rims.RESULTThis novel technique created an “in situ” aortic wall graft that was 4 cm long and characterized as being of uniform 4 mm caliber.
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