Revascularização do miocárdio sem circulação extracorpórea com enxertos arteriais: análise de 300 casos

Abstract

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

Perfil ventilatório dos pacientes submetidos a cirurgia de revascularização do miocárdio

“…The incidence of pulmonary complications of patients on the preoperative period can be noted on the 1 st postoperative day and on the 6th postoperative day. A greater number of radiographs changed on the 6 th postoperative day was found (78%) compared to the 1st postoperative day (40%), occurring on intubation, decrease of respiratory complications and thus resulting in reduced length of hospital stay associated with the reduction in hospital costs [5,8,10,20,21].…”