Revascularização miocárdica em pacientes octogenários: estudo retrospectivo e comparativo entre pacientes operados com e sem circulação extracorpórea

Abstract

Objective: The purpose of the present study is to compare and analyze the benefits of this operation with and without cardiopulmonary bypass in octogenarian patients. Method: Retrospective data of patients aged eighty years or more from December 1995 to December 2003 were analyzed. During this period 73 patients were submitted to coronary artery bypass grafting (CABG), 26 (35.6%) on-pump and 47 (64.4%) off-pump. A comparison was made of the demographic data, preoperative risks, concurrent morbid conditions, types of angina, postoperative complications and surgical outcomes between the on-pump and off-pump groups. The Student t-test was used to compare the groups and the level of significance was set at p-value < 0.05. Results: Both groups showed a high preoperative risk, although the off-pump group presented less surgical mortality (11.5% vs. 2.1%, p < 0.05). No strokes were observed in the patients operated on off-pump (11.5% vs. 0.0%, p < 0.005). Atrial fibrillation (AF) in the immediate postoperative period was present less often in the off-pump group (30.8% vs. 12.8%, p < 0.005). The postoperative mechanical ventilation time and the presence of respiratory failure were less in the off-pump group (p < 0.005). The presence of acute renal insufficiency (ARI) was 19.2% in the on-pump group and 0% in the off-pump group (p < 0.05). There was less need for transfusion of blood or blood derivatives in the off-pump group (69.2% vs. 31.9%, p < 0.005). The mean sojourn in the intensive care unit (ICU) was shorter in the off-pump group (p < 0.05). The percentage of patients with no postoperative complications was higher in the off-pump group than in the on-pump group (89.4% vs. 61.5%, p <0.001). Conclusions: The present study suggests that patients aged eighty years and over benefit when submitted to off-pump CABG and that this procedure is associated with low rates of postoperative complications such as strokes, AF, ARI and respiratory insufficiency, and with less time in the ICU, a shorter hospital sojourn, less use of blood derivatives and lower mortality. In octogenarian patients off-pump CABG is a safe and effective technique, and may be the operation of choice when correctly indicated.

Fatores de risco para mortalidade em octogenários submetidos a cirurgia de revascularização miocárdica

“…The mortality in our series of cases (11%) was similar to that reported in the literature 13,14 . The analysis of our case material showed that 61 patients (37%) had three or more revascularized arteries, and that in 97% of cases the left anterior descending artery was involved.…”

A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada

“…Thus, the incidence of myocardial infarction was 3.4% vs 2.8%; stroke (CVA) was 0% vs. 4%; assisted ventilation > 24 hours 27.4% vs 21.1% and reoperation 2.9% vs. 1.9%, respectively for on-pump vs. of-pump CABG [18]. In a similar analysis, Lee et al [19] retrospectively compared the results of on-pump vs. off-pump CABG. They found that on-pump CABG had a higher mortality rate compared to off-pump CABG (11.5% vs. 2.1%, respectively).…”

Sobrevida em longo prazo de octogenários submetidos à cirurgia de revascularização miocárdica isolada

“…When the number of patients was smaller, Likosky et al [3] and Alexander et al [4] observed a mortality of 7.7 and 8.1%, respectively. Two national studies [5,6] with octogenarian patients observed mortality of 10.0% and 11.5%. Regarding survival of octogenarians undergoing CABG, previous studies have shown that these patients have similar survival [2] or even higher probabilities [7] to live longer that the general population.…”