Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheres

Abstract

Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheresComparative study between on-pump and off-pump coronary artery bypass graft in women of Abstract Background: It has been well documented that women have higher morbidity and mortality rates than men following coronary artery bypass graft (CABG) surgery. In view of this evidence, it is necessary to know if there is benefit to off-pump CABG surgery in women in comparison to on-pump CABG.Objectives: Compare outcomes between off-pump CABG and on-pump CABG in women.Methods: Retrospective study. Our investigation analyzes comparatively clinical profile, thirteen procedure complications and mortality of a population of 941 consecutive women undergoing CABG surgery (549 off-pump and 392 on-pump) at two hospitals for the period January 2000 to December 2005.Results: Mortality rate for women undergoing off-pump CABG surgery is lower than for women undergoing on-pump surgery, however, not statistically significant (3.1% vs 5.3%; P=0.134). The complication rates analyzed (hemorrhagic shock, neurologic, respiratory, acute renal failure, adult respiratory distress syndrome, septicemia, pneumonia, atrial fibrillation) were lower (significant statistically difference) for women off-pump than women on-pump, with the exception of low cardiac output and wound infection.Conclusions: Evidence suggests that off-pump CABG surgery may be better for women than on-pump CABG 239 SÁ, MPBO ET AL -Comparative study between on-pump and off-pump coronary artery bypass graft in women Bras Cir Cardiovasc 2010; 25(2): 238-244 in outcomes in female patients undergoing on-pump CABG compared with those undergoing OPCAB, tracing the preoperative clinical profile and analyzing the differences in rates of complications and possible differences in mortality rates. Rev METHODSWe studied 941 female patients undergoing CABG with two centers:

Análise dos resultados imediatos da cirurgia de revascularização do miocárdio com e sem circulação extracorpórea

“…The benefits of the off-pump CABG surgery in the elderly [19], in patients undergoing hemodialysis [20] and, lately, in females [21] were shown in several subgroups of patients. In Brazil, other services have recorded their experiences demonstrating that myocardial revascularization without cardiopulmonary bypass is a procedure that can be performed with low surgical risk and with excellent results [22].…”

Mortalidade perioperatória em diabéticos submetidos à cirurgia de revascularização miocárdica

“…It has been noted that CPB is associated with higher levels of activated complement factors and markers of endothelial injury 12 . These effects are expressed in the clinical arena with a decrease of complications that increase mortality, such as renal failure, stroke, infections, atrial fibrillation, need for blood transfusions and low cardiac output 13 .…”

Myocardial revascularization without cardiopulmonary bypass

“…During the next decade, there were mainly observational studies and few randomized clinical trials comparing on and off pump coronary artery surgery in terms of morbidity, mortality, inflammatory response, patency rates, stroke, blood transfusion, costs, hospital mortality in high risk patients, and others [30][31][32][33][34][35][36][37][38][39][40][41]. Controversial results from these studies led to different opinions regarding the routine application of off pump coronary surgery [42][43][44][45][46][47][48].…”