<![CDATA[<B>Total myocardium revascularization without extracorporeal circulation</B>: <B>five-year experience</B>]]>

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.

Advances in Coronary Heart Disease Surgery in Latin America

“…6 From 1996 to 1998, Brazilian registries showed a mean age of 59.9 years (SD 10) for patients undergoing CABG, 7 and recent data revealed an increase to 63.12 years (SD 8.76). 8 A similar trend was recently reported in Argentina, with a mean age of 63.3 years (SD 9.5). 9 Meanwhile, women seem to be most frequently included in the series of patients Ͼ80 years old who are undergoing operation, with a rate of 28.57% compared with only 13.23% in the group Ͻ70 years old.…”

“…Reports from different South American countries describe the following associated diseases: renal insufficiency, 1.6%; gastrointestinal disease, 1%; peripheral vascular arterial disease, 3%; stroke, 3%; and chronic obstructive pulmonary disease, 4.7%. 8 …”

Is it time to adopt beating-heart coronary artery bypass grafting? A review of literature

“…The compression device (Speroni) is more associated with changes than the suction device (Octopus) [78]. Milani et al [79], in a prospective study, suggested that the operation for myocardial revascularization is safe and efficient and can be applied to all patients who need coronary surgery, with low rates of complication and mortality. In a prospective study Pinto e Silva et al [80] showed that the in-hospital outcome of elderly patients aged 70 years and older who underwent off-pump coronary artery bypass graft surgery with an intraluminal shunt in urgent, emergent, and elective coronary revascularizations associated with low rates of postoperative complications and mortality in relation to the studied population.…”

Predicting postoperative atrial fibrillation after myocardial revascularization without cardiopulmonary bypass: A retrospective cohort study

“…8,9,[11][12][13][14][15][16][17][18] Still, a few authors report PAOF frequencies lower than 15%. 4,10,15,19,20 According to most of the available literature, the use of cardiopulmonary bypass does not impact PAOF occurrence Abbreviations: AF, atrial fibrillation; DB, diagonal branch; DM, diabetes mellitus; COPD, chronic obstructive pulmonary disease; CI, confidence interval; CRF, chronic renal failure; LADA, left anterior descending artery; LMA, left marginal artery; OR, odds ratio; RCA, right coronary artery; SAH, systemic arterial hypertension. and the off-pump approach cannot be considered a protective factor for PAOF in patients undergoing CABG.…”

“…Since its development, off-pump CABG had its efficiency and safety proved and progressively became one of the preferred approaches to coronary artery disease among cardiovascular surgeons, clinical and intensive care cardiologists. 4 However, there is still some controversy regarding which technique should be used 1 : with or without CPB?…”