Revascularização do miocárdio sem circulação extracorpórea em pacientes multiarteriais: experiência de 250 casos

Abstract

MÉTODO: No período de agosto de 1997 a maio de 2001, 250 pacientes multiarteriais, consecutivos, foram submetidos à cirurgia de revascularização do miocárdio sem circulação extracorpórea. A faixa etária dos pacientes variou de 38 a 83 anos (média de 59,9 anos), dos quais 62% eram do sexo masculino. A principal indicação cirúrgica foi a insuficiência coronariana crônica (82%). Todos os pacientes foram operados por esternotomia mediana. RESULTADOS: Três (1,2%) pacientes necessitaram de instalação de circulação extracorpórea. Nos demais 247 pacientes, realizou-se 592 anastomoses, com uma média de 2,4 pontes/paciente. A artéria torácica interna esquerda foi utilizada em 198 (80,1%) pacientes, a artéria torácica interna direita em 5 (2%) pacientes e a veia safena em 247 (100%) pacientes. As artérias coronárias mais revascularizadas foram o ramo interventricular anterior (89%) e o ramo marginal esquerdo (53%). A mortalidade hospitalar global foi de 4%, sendo a principal causa o infarto pós-operatório (1,2%). Morbidade pós-operatória foi constatada em 23 (9,3%) pacientes. O tempo médio de permanência hospitalar foi de 7,7 dias. CONCLUSÃO: Conclui-se da presente investigação, que a revascularização do miocárdio sem circulação extracorpórea em pacientes multiarteriais é factível, reprodutível e com baixo índice de complicações pós-operatórias.<br>METHODS: From August 1997 to May 2001, off-pump coronary artery bypass grafting (OPCAB) was performed in 250 consecutive patients with multivessel disease. Ages ranged from 38 to 83 years (mean-age 59.9 years) and 62% of the patients were males. The main surgical indication was chronic coronary insufficiency (82%). The surgical approach was through median sternotomy in all patients. RESULTS: Three (1.2%) patients needed cardiopulmonary bypass support. In the 247 remaining patients, we performed 592 grafts (mean 2.4 grafts/patient). The left internal thoracic artery was used in 198 (80.1%) patients, the right internal thoracic artery in 5 (2%) patients and the saphenous vein in all patients (100%). The most frequently revascularized coronary arteries were the anterior interventricular branch (89%) and the obtuse marginal (53%). The mortality rate was 4% and the main primary cause of death was myocardial infarction (1.2%). Twenty-three (9.3%) patients had major complications in the postoperative period. The mean hospital stay was 7.7 days. CONCLUSION: In conclusion, OPCAB can be safely performed in patients with multivessel disease, with low rates of postoperative complications

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

“…Over the last few years, after improvements in the stabilization techniques and in the approach to the heart [18], interest in off-pump CABG has increased immensely as can be seen by works presented by different centers [7][8][9][10][11][12]. Brazilian surgeons greatly influenced this increased interest, initially with BUFFOLO et al [5] and after, with LIMA [18] and RIVETTI & GANDRA [19].…”

“…After the pioneering works of BUFFOLO et al [5] and BENETTI [6], off-pump CABG became of interest world-wide, with investigations carried out by many centers [7][8][9][10][11][12]. These studies have been published in Brazil and overseas and demonstrate the efficiency and safety of this type of surgery, which is becoming more and more popular among cardiovascular surgeons, clinical cardiologists and intensivists.…”

Treinamento muscular respiratório na revascularização do miocárdio

“…Moreover, there is respiratory muscle dysfunction, related to the loss of ability to generate force [4][5][6]. There have been found significantly lower values of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) compared with preoperative values in patients after cardiac surgery.…”

<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

“…An ever increasing number of retrospective studies and a few randomized studies have been published which clearly show the benefits of OPCAB. Most of these papers underscore the results on hospital mortality, the possibility of total revascularization using arterial conduits and the incidence of stroke, loss of cognitive function, impairment of renal function, less morbidity and shorter hospital stay, all of these results according to gender [6][7].…”

“…An ever increasing number of retrospective studies and a few randomized studies have been published which clearly show the benefits of OPCAB. Most of these papers underscore the results on hospital mortality, the possibility of total revascularization using arterial conduits and the incidence of stroke, loss of cognitive function, impairment of renal function, less morbidity and shorter hospital stay, all of these results according to gender [6][7].A multicentric study of 17,969 patients undergoing offpump surgery from the database of the American Association for Thoracic Surgery (AATS) assessed retrospectively and by statistical analysis to obtain groups with comparable risk factors (with or without cardiopulmonary bypass), showed lower in-hospital mortality in the off-pump group undergoing total revascularization [8]. MACK et al, in a study of 7,283 patients undergoing off-pump coronary bypass, showed that the use of cardiopulmonary bypass in patients over 75 years of age was a predictor for greater risk of mortality (OR 2.13 CI 95% 1.20-3.76, p= 0.01) [9].…”