Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.370
Filtrar
1.
Rev Med Chil ; 147(6): 718-726, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859824

RESUMO

BACKGROUND: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. AIM: To describe the five-year evolution of a cohort of patients operated on with this technique. MATERIAL AND METHODS: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. RESULTS: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. CONCLUSIONS: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.


Assuntos
Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Feminino , Seguimentos , Humanos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
J Card Surg ; 34(9): 788-795, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31269282

RESUMO

BACKGROUND: Coronary artery bypass grafting (CABG) can be performed through a variety of approaches. Minimally-invasive CABG (MICABG) may reduce perioperative morbidity. Previous results demonstrate improved perioperative outcomes; however, adoption has been limited. METHODS: The Society of Thoracic Surgeons (STS) database and electronic medical record at a single institution were reviewed for isolated left internal mammary to left anterior descending artery (LIMA-LAD) bypass procedures performed between 2011 and 2018. Patients were grouped on the basis of operative approach, comparing sternotomy to non-sternotomy (minimally-invasive). Patient characteristics, perioperative variables, and short- and long-term outcomes were compared. Primary outcomes included mortality and major adverse cardiac events (MACE). Secondary outcomes were morbidity. RESULTS: A total of 42 MICABG and 54 conventional LIMA-LAD procedures were performed with 95.2% of MICABG procedures performed by two surgeons. MICABG were more often elective (83.3 vs 38.9%, P < .001). STS risk scores predicted equitable mortality and morbidity for MICABG dependent on operative indication. MICABG was associated with fewer pulmonary complications (0.0 vs 11.1%, P = .033), in-hospital events (11.9 vs 37.0%, P = .005), and shorter intensive care unit (34.1 vs 66.0 hours, P = .022) and total length of stay (3.7 vs 6.5 days, P = .002). There were no observed strokes, myocardial infarctions, or reoperations. MICABG patients demonstrated reduced thirty-day mortality (0.0 vs 10.9%, P = .036) and improved Kaplan-Meier 5-year (95.2 vs 77.9%, P = .016) and MACE-free survival (89.2 vs 63.9%, P = .010). CONCLUSIONS: Minimally-invasive LIMA-LAD CABG demonstrates improved early postoperative morbidity and a long-term mortality benefit. In select patients, minimally-invasive approaches to single-vessel grafting may be beneficial when performed by experienced surgeons in the elective setting.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Artéria Torácica Interna/transplante , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/métodos , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Anastomose de Artéria Torácica Interna-Coronária/métodos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
3.
J Invasive Cardiol ; 31(6): E157, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158814

RESUMO

Left heart catheterization graft study is commonly performed via the femoral approach to allow selective angiography of internal mammary grafts, which originate from either subclavian artery. A straightforward mother-and-child catheter-extension technique allows this procedure to be performed successfully via radial approach, which improves patient comfort and offers less likelihood of vascular complications.


Assuntos
Cateterismo Cardíaco/instrumentação , Angiografia Coronária/métodos , Anastomose de Artéria Torácica Interna-Coronária/métodos , Isquemia Miocárdica/cirurgia , Idoso , Desenho de Equipamento , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Artéria Radial
4.
Heart Surg Forum ; 22(2): E092-E096, 2019 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-31013216

RESUMO

BACKGROUND: Sternal wound infection (SWI) is a major complication occurring often after coronary artery bypass grafting (CABG) using bilateral internal mammary artery (BIMA) grafts. The aim of this study is to assess whether such a risk may be reduced by using incision negative pressure wound therapy (INPWT). METHODS: Data on patients undergoing isolated CABG using BIMA grafts at the Reims University Hospital, France, from 2013 to 2016 without or with INPWT was prospectively collected.  Results: INPWT was used in 161 patients and conventional sterile wound dressing was used in 266 patients. Propensity score matching resulted in 128 pairs with similar characteristics. SWIs were similarly distributed between the conventional sterile wound dressing (10.9%) and the INPWT cohorts (10.2%) (P = 1.00). Patients treated with INPWT had a lower rate of deep SWI/mediastinitis than patients who had conventional sterile dressing (5.5% versus 10.2%, P = .210), but the difference did not reach statistical significance. Tests for interaction confirmed these findings in different patient subgroups. CONCLUSION: The routine use of INPWT may not significantly reduce the risk of SWI in patients undergoing BIMA grafting. In view of previous reports showing a benefit with the use of this method, a large randomized study is justified to assess the efficacy of INPWT in patients undergoing cardiac surgery.


Assuntos
Bandagens , Anastomose de Artéria Torácica Interna-Coronária , Tratamento de Ferimentos com Pressão Negativa , Esterno/cirurgia , Infecção da Ferida Cirúrgica/terapia , Idoso , Feminino , França , Humanos , Masculino , Pontuação de Propensão , Estudos Prospectivos
6.
Innovations (Phila) ; 14(2): 144-150, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30885086

RESUMO

OBJECTIVE: The da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) cannot give tactile feedback to surgeons. This shortcoming may increase the risk of left internal thoracic artery (LITA) injury during its harvest. We utilized Firefly Fluorescence Imaging (Firefly) to assess LITA quality in robot-assisted minimally invasive direct coronary artery bypass (R-MIDCAB). METHODS: We retrospectively reviewed clinical records and intraoperative videos of 30 consecutive patients who underwent R-MIDCAB with LITA-left anterior descending (LAD) coronary bypass. All patients had post-harvest assessment of LITA blood flow by Firefly with 1 mL (2.5 mg/mL) of indocyanine green injection through a central line. RESULTS: Twenty-seven of the patients were male, mean age was 67.7 ± 10.7 years. In post-harvest assessment performed before transection of the distal LITA, blood flow in LITA was well visualized in 28 patients. In the remaining 2 patients, 1 had dissection and the other had severe spasm of the LITA. Firefly was also useful for locating LITA and LAD and for assessing blood flow of the graft after anastomosis. Time required for each Firefly assessment was approximately 20 seconds. There were no side effects or complications due to Firefly intraoperatively and postoperatively. Twenty-six patients had postoperative coronary computed tomography; LITA patency rate was 100% (26/26). CONCLUSION: Firefly is fast, simple, and effective for locating and assessing flow in LITA and LAD before and after anastomosis in R-MIDCAB.


Assuntos
Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/transplante , Idoso , Anastomose Cirúrgica , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Revascularização Miocárdica/instrumentação , Revascularização Miocárdica/métodos , Imagem Óptica/métodos , Período Pós-Operatório , Estudos Retrospectivos , Robótica
9.
Heart Surg Forum ; 22(1): E045-E049, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30802197

RESUMO

BACKGROUND: Despite the superior hemodynamic performance of internal thoracic arteries, total arterial revascularization with exclusive bilateral internal thoracic arteries (BITA) is less frequently used especially in specific subsets of patients, including females. We report our experience with total arterial revascularization with exclusive BITA regardless of sex and analyze the impact of female sex on the early and midterm outcomes. METHODS: Total arterial revascularization with exclusive BITA was performed with equal frequency in females (79/99, 80%) and males (392/477, 82%; P = .68) undergoing isolated CABG for 3-vessel disease. Pre, intra and postoperative data were compared between these two groups. RESULTS: Complete revascularization was achieved in 77% of females and 72% of males (P = .08). Early mortality did not differ between the groups (6.3% versus 4.6%, P = .7). The incidence of re-sternotomy for bleeding, postoperative stroke, myocardial infarction, new onset atrial fibrillation, and hemofiltration for renal failure did not differ between the two groups. However, there were significantly more wound revision for combined superficial and deep sternal wound infection in females (26.5% versus 5.1%, P = .0001). Nevertheless, midterm survival, freedom from repeat revascularization, myocardial infarction, stroke, and major adverse cardiovascular and cerebral events at five years were very good and compared favorably between females and males. CONCLUSIONS: Our findings suggest that total arterial myocardial revascularization with exclusive internal thoracic arteries in females carries the same midterm benefits as in males. Early outcomes are comparable except for a higher incidence of wound revision for combined superficial and deep sternal wound infections in females compared to males. Benefits of bilateral internal thoracic artery grafting in females should be weighed against increased risk of early wound revision.


Assuntos
Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/transplante , Complicações Pós-Operatórias/epidemiologia , Medição de Risco , Idoso , Feminino , Seguimentos , França/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Cardiovasc J Afr ; 30(1): 57-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720843

RESUMO

OBJECTIVE: The rate of patients with diffuse left anterior descending artery (LAD) disease being referred for surgery has increased as a result of advances in endovascular techniques. In surgery of diffuse or multisegment LAD disease, surgical procedures with or without endarterectomy can be performed. In this article, we report our results of longsegment onlay patchplasty of the LAD with a left internal thoracic artery (LITA) graft without endarterectomy, on the beating heart, in patients with multisegment LAD disease. METHODS: We retrospectively analysed patients who underwent coronary artery bypass grafting surgery in our hospital between 1 January 2015 and 31 July 2017. We included LITA onlay patchplasty patients with multisegment LAD disease who had been operated on the beating heart. We excluded patients who underwent coronary endarterectomy and were operated on under cardiopulmonary bypass. RESULTS: In this period, 54 patients with multisegment LAD disease were treated with LITA patchplasty on the beating heart. The mean length of the arteriotomy was 42.8 ± 13.3 mm (25-75 mm). There were two postoperative myocardial infarctions (3.7%) and three deaths (5.5%). In the remaining patients, there was no haemodynamic instability that needed long-term (> 24 hour) inotropic support. Patients were discharged from hospital on postoperative 9.3 ± 7.1 days with dual antiplatalet therapy. CONCLUSIONS: Bypass grafting of the LAD with long-segment LITA onlay patchplasty can safely be performed in patients with multisegment LAD disease, with acceptable early-term results. In this procedure, proximal and distal segments of the diseased LAD are revascularised with LITA grafts, which may improve long-term survival and quality of life.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Ann Thorac Surg ; 107(1): e37-e39, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29890151

RESUMO

Enlarging left ventricular pseudoaneurysms are a rare complication (especially after surgical revascularization) and require tailored surgical decision making and techniques for repair. We present a challenging patient with a rapidly enlarging left ventricular pseudoaneurysm 4 weeks after coronary bypass. The repair was approached through a left thoracotomy using circulatory arrest with selective antegrade cerebral perfusion.


Assuntos
Falso Aneurisma/cirurgia , Ventrículos do Coração/cirurgia , Anastomose de Artéria Torácica Interna-Coronária , Complicações Pós-Operatórias/cirurgia , Toracotomia/métodos , Idoso , Falso Aneurisma/diagnóstico por imagem , Parada Circulatória Induzida por Hipotermia Profunda , Angiografia por Tomografia Computadorizada , Doença das Coronárias/cirurgia , Progressão da Doença , Ecocardiografia , Emergências , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem
14.
Cardiovasc Interv Ther ; 34(1): 1-8, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29210019

RESUMO

The internal mammary artery (IMA) is the most durable conduit for bypassing the left anterior descending (LAD) coronary artery in patients undergoing coronary artery bypass graft surgery (CABG). However, little is known about how the IMA reacts histologically to stent implantation. From CVPath stent registry (1048 lesions, 614 cases), we obtained 4 stent lesions (2 bare metal stents, 2 drug-eluting stents) involving IMA grafts. The mean age of our patients was 63 years and the duration of stent implantation in the IMA ranged from 5 days to 5 years. Stented arteries were dissected from hearts and embedded in plastic, segmented at 3 mm intervals, sectioned at 4-6 microns and stained with H&E and Movat pentachrome stains. Histological observations were performed. Majority of stents (3 of 4) were implanted in anastomosis between IMA and LAD while 1 stent was implanted in IMA body. One stent with duration of 5 days showed stent thrombosis while others were all patent with fully coverage by varying degrees of neointima. Foamy macrophage, lipid pool and calcification in neointima were observed in 1 stent with duration of 5 years but it was limited only to the distal LAD part within the stented segment. Overall, in this small pathologic series, the majorities of stents were implanted in IMA-to-LAD anastomosis site and demonstrated acceptable pathologic responses.


Assuntos
Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/patologia , Stents/efeitos adversos , Adulto , Idoso , Vasos Coronários/cirurgia , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Masculino , Artéria Torácica Interna/cirurgia , Sistema de Registros
15.
Am J Cardiol ; 123(4): 571-575, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30538035

RESUMO

Although in situ internal mammary artery (is-IMA) grafting remains the most frequent conduit in coronary artery bypass grafting (CABG), circumstances may necessitate free grafting of the IMA (f-IMA), though differences in outcomes have not been fully characterized. The purpose of this study was to compare clinical and angiographic outcomes of is-IMA versus f-IMA coronary bypass grafts in patients who underwent elective CABG surgery. In 1,829 patients in the angiographic cohort of PREVENT IV, 1,572 (85.9%) had at least 1 IMA graft; of these, 34 (2.2%) patients had at least 1 f-IMA graft and 1,538 (97.8%) had at least 1 is-IMA graft without additional f-IMA grafts. Characteristics of patients, procedure, and grafts/targets were compared between cohorts. Primary endpoints included death, myocardial infarction, and revascularization, as well as incidence of graft failure (stenosis >75%) on angiography at 12-18 months postoperatively. Patients receiving is-IMA grafts were more often of white race and higher weight. Aortic cross-clamp time was shorter in the f-IMA cohort (39.5 vs 57.0 min, p = 0.04), but duration of bypass was similar (93.5 vs 100.0 minutes, p = 0.793). Of the in situ grafts, 97.3% were via the left internal mammary artery (LIMA), 86.6% were of good quality, and the left anterior descending (LAD) was bypassed in 88.2%. This compares with free grafts, which were via the LIMA in 68.0%, of good quality in 96.1%, and bypassed the LAD in 58.8% and first obtuse marginal (OM1) in 23.5%. Rates of death, myocardial infarction, and revascularization were similar between groups. The rate of graft failure was higher in f-IMA grafts (23.3%) compared with is-IMA grafts (8.5%; p < 0.01). Although clinical outcomes were similar with use of free versus in situ IMA grafts, higher rates of graft failure were encountered with use of the f-IMA graft. In conclusion, in situ grafts should be the preferred conduit for patients who undergo CABG surgery.


Assuntos
Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/epidemiologia , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Infarto do Miocárdio/epidemiologia , Reoperação , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Anastomose de Artéria Torácica Interna-Coronária/métodos , Masculino , Pessoa de Meia-Idade , Falha de Tratamento
16.
Ann Thorac Surg ; 107(3): 740-746, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30395856

RESUMO

BACKGROUND: Internal thoracic artery (ITA) grafts are the most durable conduits available for coronary artery bypass grafting (CABG). However, little is known about long-term angiographic outcomes of ITA grafts used in different configurations and whether sequential or Y grafting compromises patency of the inflow ITA graft. METHODS: From January 1972 to August 2016, 60,500 patients underwent primary isolated CABG, of whom 326 received ITA grafts placed in sequential or Y configuration and were studied angiographically (median 4.8 years to first follow-up angiogram). Each sequential or Y segment was studied individually using a mixed-effects longitudinal model with the patient as the random effect. RESULTS: At 15 years, patency of the proximal ITA segment (n = 331) was 99%; of a sequential segment (n = 222), 97%; and of the segment beyond anastomosis of a Y graft (n = 109), 99%. Patency of the Y grafts (n = 109) was 92% at 5 years, 91% at 10 years, and 90% at 15 years. After adjusting for proximal stenosis and graft location, Y grafts were associated with greater occlusion than the inflow segment of ITA grafts (odds ratio; 51, 95% confidence interval, 6.1 to 422; p = 0.003) and of sequential grafts (odds ratio, 12; 95% confidence interval, 1.14 to 120; p = 0.04). CONCLUSIONS: Long-term patency of ITA grafts in sequential or Y configuration is similar qualitatively, but not quantitatively, to the known patency of single ITA-to-left anterior descending grafts. Sequential or Y grafting does not compromise patency of the inflow portion of an ITA graft. Y-graft patency is lower than sequential graft patency but is still better than known patency of saphenous vein grafts.


Assuntos
Estenose Coronária/cirurgia , Previsões , Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/transplante , Grau de Desobstrução Vascular/fisiologia , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Artéria Torácica Interna/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Coron Artery Dis ; 30(1): 67-73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30407209

RESUMO

BACKGROUND: The use of two bilateral internal thoracic artery grafting (BITA) was shown to lead to survival benefit. However, operators are reluctant to use BITA with peripheral vascular disease (PVD) because of concerns of increased rates of sternal wound infection and lack of studies supporting survival benefit compared with single internal thoracic artery (SITA) grafting. The aim of this study is to compare outcome BITA grafting versus of SITA and vein grafts in PVD patients. PATIENTS AND METHODS: Six hundred and twenty-one PVD patients who underwent BITA between 1996 and 2011 were compared with 372 patients who underwent SITA. RESULTS: SITA patients were older and more likely more likely to have comorbidities (female, insulin-dependent diabetes, chronic obstructive lung disease, congestive heart failure, previous coronary artery bypass grafting, renal insufficiency, cerebrovascular disease, and emergency operation). Operative mortality (5.1 vs. 4.5%, in the SITA and BITA, respectively, P=0.758), rate of sternal wound infection (5.1 vs. 3.9%, P=0.421), and strokes (4.8 vs. 7.4%, P=0.141) were not significantly different between groups. BITA patients did not have significantly better 10-year survival (52.6 vs. 45.9%, P=0.087) and after propensity score matching (302 well-matched pairs), BITA was not associated with improved survival (hazard ratio: 0.902; 95% confidence interval: 0.742-1.283; P=0.784) (Cox model). CONCLUSION: The routine use of BITA versus SITA in PVD patients does not improve long-term survival. Selective use of BITA in lower risk patients might unmask the benefits of BITA.


Assuntos
Implante de Prótese Vascular/métodos , Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/transplante , Doenças Vasculares Periféricas/cirurgia , Medição de Risco , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Masculino , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
18.
Ann Thorac Surg ; 107(4): 1166-1173, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30444991

RESUMO

BACKGROUND: To minimize aortic manipulation and maximize use of arterial conduits are aims of modern coronary surgery. METHODS: From March 2012 to October 2016, 890 consecutive patients with multivessel coronary disease underwent isolated coronary operations using both internal thoracic arteries (ITAs). In 205 (23%; mean age, 67.6 ± 9.2 years), the right ITA was proximally transected and used as a free graft, while its in situ stump was elongated with a saphenous vein graft. The new arteriovenous I conduit was directed to the inferolateral cardiac wall. Operative data and early outcomes of these patients (I group) were compared with the remaining 685 patients (control [C] group). Early and late outcomes were also compared in 184 pairs identified with propensity score matching. RESULTS: Between the I and C groups there was no significant difference in expected operative risk (European System for Cardiac Operative Risk Evaluation II, p = 0.28), although diseased ascending aorta (p < 0.0001) and critical preoperative state (p = 0.027) were more frequent in the I group. Despite a higher number of coronary anastomoses (mean, 4 ± 0.9 vs 3.7 ± 1, p < 0.0001), cardiopulmonary bypass time was shorter in the I group both in overall (86.7 ± 23.7 vs 105.7 ± 34.2 minutes, p < 0.0001) and matched series (86.8 ± 24.1 vs 108.8 ± 31.9 minutes, p < 0.0001). In-hospital mortality (1% vs 1.9%, p = 0.54) and the rates of postoperative complications were similar. During the follow-up period, no intergroup difference was found in matched patients in the nonparametric estimates of freedom from all-cause death (p = 0.39) and major adverse cardiac and cerebrovascular events (p = 0.44). CONCLUSIONS: Surgery using this arteriovenous I conduit is safe, minimizes aortic manipulation, shortens cardiopulmonary bypass time, and aids complete revascularization.


Assuntos
Fístula Anastomótica/prevenção & controle , Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Mortalidade Hospitalar , Anastomose de Artéria Torácica Interna-Coronária/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Feminino , Seguimentos , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologia
19.
Khirurgiia (Mosk) ; (11): 96-99, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30531763

RESUMO

Endoscopic harvesting of internal mammary artery for minimally invasive coronary artery bypass surgery seems to be highly justified and expedient. Technical features of this procedure are reviewed in the article. There are certain advantages of this method including ligation of proximal branches, reduced surgical trauma, better cosmetic results and enhanced postoperative rehabilitation.


Assuntos
Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna/transplante , Coleta de Tecidos e Órgãos/métodos , Endoscopia , Humanos , Ligadura , Artéria Torácica Interna/cirurgia
20.
ABC., imagem cardiovasc ; 31(4)Out.- Dez. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-964027

RESUMO

Fundamento: Ocorre modificação no fluxo da artéria torácica interna, após sua anastomose na artéria coronária descendente anterior. Objetivo: Avaliar o efeito da ligadura dos ramos proximais da artéria torácica interna anastomosada na artéria coronária descendente anterior, quanto às velocidades e à reserva de velocidade de fluxo coronariano, em pacientes com fração de ejeção do ventrículo esquerdo preservada (> 50%). Métodos: Estudo prospectivo de pacientes com fração de ejeção do ventrículo esquerdo > 50% revascularizados. O Grupo I foi formado por 25 pacientes com ligadura dos grandes ramos da artéria torácica interna antes de sua anastomose na artéria coronária descendente anterior, e o Grupo II por 28 pacientes sem ligadura. Registrou-se o Doppler em nível proximal da artéria torácica interna no pré-operatório, pós-operatório precoce e no pós-operatório tardio de 6 meses. Foram mensurados os picos de velocidade sistólica e diastólica, e as velocidades médias sistólica e diastólica. A reserva de velocidade de fluxo coronariano foi obtida durante o ecocardiograma sob estresse com dobutamina no pós-operatório tardio de 6 meses. Resultados: No pós-operatório precoce, o pico de velocidade sistólica e a velocidade média sistólica diminuíram, enquanto aumentaram o pico de velocidade diastólica e a velocidade média diastólica nos dois grupos (p < 0,05). Do pós-operatório precoce para o tardio em 6 meses, apenas o pico de velocidade diastólica se modificou, diminuindo nos dois grupos (p < 0,05). Durante o ecocardiograma sob estresse com dobutamina, o pico de velocidade diastólica e a velocidade média diastólica aumentaram (p < 0,05), e os grupos não diferiram, mas o pico de velocidade sistólica e a velocidade média sistólica aumentaram apenas no Grupo II (p < 0,05). A reserva de velocidade de fluxo coronariano dos grupos calculada pelo pico de velocidade diastólica (Grupo I = 2,17 ± 0,64 e Grupo II = 2,28 ± 0,63) e pela velocidade média diastólica (Grupo I = 2,27 ± 0,54 e Grupo II = 2,5 ± 0,79) não diferiu. Conclusão: Em pacientes com fração de ejeção do ventrículo esquerdo preservada, a ligadura dos grandes ramos da artéria torácica interna anastomosada na artéria coronária descendente anterior não compromete a reserva de velocidade de fluxo coronariano, mas determina limitação no aumento das velocidades sistólicas


Introduction: Modification of internal thoracic artery flow occurs after its anastomosis in the left anterior descending coronary artery. Objective: To evaluate the effect of ligation of the proximal branches of anastomosed internal thoracic artery flow on the left anterior descending in relation to velocities and coronary flow velocity reserve in patients with left ventricular ejection fraction preserved (> 50%). Methods: Prospective study of patients with left ventricular ejection fraction > 50% and revascularized. Group I was composed of 25 patients with ligation of the major branches of the internal thoracic artery flow before its anastomosis in the left anterior descending coronary artery, and Group II was composed of 28 patients without ligation. Doppler was recorded at the proximal level of internal thoracic artery flow in the preoperative, early postoperative and 6 months later. The systolic peak velocity and diastolic, and systolic mean velocity and diastolic were measured. Coronary flow velocity reserve was obtained during dobutamine stress echocardiography in postoperative period 6 months later. Results: In the postoperative, the systolic peak velocity and the systolic mean velocity decreased while increasing the diastolic peak velocity and the diastolic mean velocity in the groups (p < 0.05). From the postoperative to the postoperative period 6 months later, only the diastolic peak velocity modified, occurring its decrease in the groups (p < 0.05). During the dobutamine stress echocardiography, diastolic peak velocity and the diastolic mean velocity increased (p < 0.05) and groups did not differ, however, the systolic peak velocity and the systolic mean velocity increased only in Group II (p < 0.05). The coronary flow velocity reserve of the groups calculated by diastolic peak velocity (Group I = 2.17 ± 0.64 and Group II =2.28 ± 0.63) and diastolic mean velocity (Group I = 2.27 ± 0.54 and Group II = 2.5 ± 0.79) did not differ. Conclusion: In patients with preserved left ventricular ejection fraction, the ligation of the large branches of the anastomosed internal thoracic artery flow into the left anterior descending coronary artery does not compromise the coronary flow velocity reserve, but determines limitation in the increase of the systolic velocities


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Reserva Fracionada de Fluxo Miocárdico , Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna/cirurgia , Revascularização Miocárdica/métodos , Atropina/administração & dosagem , Volume Sistólico , Transplante , Ecocardiografia/métodos , Ecocardiografia Doppler/métodos , Análise Estatística , Estudos Prospectivos , Análise de Variância , Ecocardiografia sob Estresse/métodos , Dobutamina/administração & dosagem , Ventrículos do Coração
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA