Revascularização total do miocárdio sem circulação extracorpórea: cinco anos de experiência

Abstract

Objective: To evaluate the immediate postoperative results of off-pump myocardium revascularization surgery by analyzing complications and mortality. Method: A total of 1440 patients were submitted to offpump myocardium revascularization. The surgical technique consisted in proximal occlusion of the approached artery, the application of the LIMA graft in the posterior pericardial deflection and stabilization of the target artery with a suction stabilizer. The distal anastomoses were performed first. Results: Among the patients evaluated, 924 were male and 516 were female, with a mean age of 63.12 ± 8.76 years. The ejection fraction was normal in 749 patients, 740 (51.4%) patients had suffered previous myocardial infarction and 687 (47.6%) patients were in functional class III or IV. The mean EuroSCORE was 4.93 ± 3.32. The mean number of distal anastomoses was 3.12 ± 1.23 per patient. A total of 1173 (81.5%) patients remained less than 12 hours on mechanical ventilation and among these, 888 (61.7%) remained for less than six hours. The stay in the ICU was of one night for 330 (22.8%) patients, for two nights for 930 (64.6%) patients and 182 (12.4%) patients remained for three or more nights. In regards to complications, three (0.2%) patients presented with renal insufficiency, six (0.4%) patients suffered strokes, nineteen (1.3%) patients were reoperated for bleeding, nineteen (1.3%) patients had mediastinitis, eighteen (1.25%) patients suffered severe myocardial infarction and 212 (14.7%) presented atrial fibrillation. There were 50 (3.5%) deaths, 29 (2.5%) of them being among the 1148 patients operated electively, 9 (4.7%) among 190 patients submitted to coronary re-operation and 12 (11.7%) among 102 patients undergoing emergency operations. Conclusion: With the evolution of biomedical technological, all the vessels of the heart are now approached. These data suggest that the operation for myocardial revascularization is safe and efficient. It can be applied to all patients who need coronary surgery, with low rates of complication and mortality.

Prevalência e fatores de risco para insuficiência renal aguda no pós-operatório de revascularização do miocárdio

“…The changes caused by the use of cardiopulmonary bypass include contact with nonendothelial surfaces, the exclusion of pulmonary flow, the presence of continuous minimally pulsatile or nonpulsatile flow and the onset of endocrine-metabolic response is proportional to a major surgery, all this culminating in an inflammatory response not susceptible to external control [23]. The positive impact of the absence of CPB on renal function in postoperative of heart surgery can be observed in the study by Milani et al [24], in which only 0.2% of patients developed ARF, a value less than that found in studies in which CPB was used [25,26]. In another study, developed by Lima et al [27], assessing octogenarian patients undergoing CABG surgery, the presence of ARF was 19.2% in the on-pump group and none in patients without CPB.…”

Influências temporais nas características e fatores de risco de pacientes submetidos a revascularização miocárdica

“…It is difficult to establish if the surgical mortality result would be affected by MCR procedures without extracorporeal circulation, although recent studies have proven that this technique produces positive results in regard to morbidities 28,29 . A recent study questions the applicability of the risk scores developed for conventional MCR in relation to MCR procedures without extracorporeal circulation 30 .…”

Revascularização do miocárdio sem circulação extracorpórea em pacientes submetidos à hemodiálise

“…The anesthetic procedure was the same as is routinely utilized in the service [16] however with more care in respect to the dosage of muscle relaxant and, in particular, in relation to the quantity of fluids taken. On completing anesthetic induction, grafts were harvested in the normal manner [16,17].…”