Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.190
Filtrar
1.
J Card Surg ; 35(8): 1958-1978, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32643847

RESUMO

BACKGROUND: Operative technique for surgical myocardial revascularization in high-risk patients remains an argument of debate. On-pump coronary artery bypass graft (CABG) with cardioplegic arrest and off-pump CABG have intrinsic limitations. The hybrid approach of on-pump beating-heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta-analysis intends to summarize the contemporary literature. METHODS: A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. RESULTS: Compared with on-pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36-0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39-0.91). Also, interesting trends towards reduced postoperative intra-aortic balloon pump use (RR, 0.56, 95% CI, 0.31-1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22-1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off-pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off-pump CABG (RR, 0.53, 95% CI, 0.33-0.87) but higher than conventional on-pump CABG (RR, 1.71, 95% CI, 1.23-2.39). CONCLUSION: OPBHC is an effective technique to perform surgical revascularization in high-risk patients as preventing haemodynamic deterioration and guaranteeing adequate end-organ perfusion. OPBHC represents an alternative technique to on-pump and off-pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/complicações , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Infarto do Miocárdio/complicações , Complicações Pós-Operatórias/prevenção & controle , Risco , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
2.
Zhonghua Wai Ke Za Zhi ; 58(5): 363-368, 2020 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-32393003

RESUMO

Objective: To examine the safety and efficacy of minimally invasive coronary surgery-coronary artery bypass grafting (MICS-CABG). Methods: From the first case in November 2015 to November 2019, a total of 244 cases of MICS-CABG were performed in Department of Cardiovascular Surgery, Peking University Third Hospital. There were 197 males and 47 females, aging (62.3±8.7)years (range: 36 to 88 years). The operations were performed via the 5(th) intercostal space of left thoracic lateral incision (length: 4 to 5 cm extended for 8 to 10 cm), and were performed under off-pump, with the help of the chest wall suspension device and cardiac fixator. The proximal anastomosis on ascending aorta and the distal anastomosis of left anterior descending branch, circumflex branch and right coronary system were completed according to procedure. In all 244 cases, the proportion of 2 grafts was 53.7% (131 cases), 3 grafts was 36.1% (88 cases), 4 grafts was 9.8% (24 cases) and 5 grafts was 0.4% (1 case). The average of grafts was 2.6±0.7 (range: 2 to 5). The proportion of hybrid was 14.3% (35 cases), sequential bypass procedure was 43.0% (105 cases) and multiple artery grafts was 25.4% (62 cases). The perioperative complications of the patients were collected, the patency rate of the grafts was evaluated by coronary angiography or CT within 7 days after the operation, and main adverse cardiovascular and cerebrovascular events (MACCE) were followed up. The survival curve was drawn by Kaplan-Meier method, and the 1-year MACCE rate was calculated by survival analysis. Results: All cases had no transition to thoracotomy and cardiopulmonary bypass procedure, and no cases needed intra aortic balloon pumping and extracorporeal membrane oxygenation during the operation.There were 2 cases of poor incision healing, and reoperation was performed in 10 cases (6 cases of postoperative bleeding, 2 cases of incision debridement, and 2 cases of grafts problems). The rate of MACCE in 30 days was 2.6% (10 cases), which contained 3 cases of death (2 cases of grafts occlusion, 1 case of serious hemorrhage after thoracic puncture drainage), 3 cases of stroke and 5 cases of non-fatal myocardial infarction. By the re-examination of angiography in 7 days after operation, the overall patency of the grafts was 96.1%, and the patency of the left anterior descending was 98.6%. Kaplan-Meier survival analysis was conducted for 235 patients (96.3%) with 1 to 36 months follow-up results, and the 1-year MACCE rate was 5.6% (95%CI: 4.2% to 7.0%) . There was no significant difference among the incidences of MACCE at each stage of learning curve. Surgeon could reduce the operation time and complete more anastomosis with the accumulation of experience after the early 30 cases. Conclusions: MICS-CABG can safely achieve completed revascularization, which has good operative effects in short and medium-long term. There is no significant risk in the early cases of learning curve.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
J Card Surg ; 35(3): 729-731, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32017226

RESUMO

A left anterior descending artery (LAD) arising from the right coronary artery (RCA) or right sinus of Valsalva is an exceedingly rare anomalous variant occurring in 0.03% of the population. We here present the case of an 81-year-old male with severe triple vessel coronary artery disease who was found to have an aberrant LAD arising from the proximal RCA, and was successfully treated with off-pump, total arterial, and complete surgical revascularization.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Idoso de 80 Anos ou mais , Humanos , Masculino , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-31990154

RESUMO

Off-pump, total arterial coronary artery bypass grafting (CABG) is a technically demanding myocardial revascularization strategy that combines the long-term benefits of multi-arterial CABG with a no-touch aortic technique. Dedicated training and mentoring are essential in order to learn how to successfully perform this challenging surgical procedure.  In this video-tutorial, we present  a complete step-by-step approach to safely reproduce this procedure. We will cover the harvesting techniques adopted for internal mammary arteries (ITAs) and for the radial artery (RA), and the several options to construct and deploy multi-arterial composite grafts ("T/Y", "K", and "I" grafts), with a focus on minimizing aortic manipulation.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Humanos , Artéria Torácica Interna/cirurgia , Artéria Radial/transplante
6.
Artigo em Inglês | MEDLINE | ID: mdl-31990160

RESUMO

The tips and tricks of robotic totally endoscopic coronary artery bypass have not been fully described. In this video tutorial, we present our experience and provide information about  technical considerations and other details that will help support surgeons interested in starting a totally-endoscopic coronary artery bypass surgery program.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Endoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Masculino , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade
8.
Ann Thorac Surg ; 109(1): e63-e65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31518590

RESUMO

Proper positioning of the heart through a small left thoracotomy is the main challenge during off-pump minimally invasive cardiac coronary artery bypass grafting. Here we report a novel technique for target vessel exposure using the Tentacles NEO (Sumitomo Bakelite, Co Ltd, Tokyo, Japan) multisuction heart positioner, a device with 3 independent small suction cups that can be applied to various surfaces of the heart and pulled toward any direction using attached traction cords. The armless design of the device enables the use of flexible exposure techniques and contributes to the safety and feasibility of minimally invasive coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/instrumentação , Toracotomia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Desenho de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Sucção/instrumentação , Toracotomia/métodos
9.
Int Heart J ; 60(6): 1276-1283, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735768

RESUMO

Consensus has yet to emerge among experts as to whether the radial artery (RA) conduit was superior to the saphenous vein (SV) graft for coronary artery bypass grafting (CABG) in terms of long-term patency. This study aimed to evaluate long-term patency of the RA conduit compared to the SV conduit for off-pump CABG, and to screen the independent predictors of long-term RA graft failure.Patients < 80 years of age with graftable triple-vessel disease undergoing non-emergent, primary, isolated off-pump CABG, using both the RA and the SV conduits, were reviewed. Graft patency, all-cause mortality and repeat revascularization were followed-up. The independent predictors of long-term RA graft failure were identified.A total of 296 out of 320 eligible patients (42 females, 61.3 ± 9.9 years old) received follow-up with an observed period of 93.4 ± 16.5 months. All-cause mortality was 14.5%, and repeat revascularization was conducted on 6 RA grafts and 9 SV grafts. Superior patency of the RA grafts compared to the SV grafts was observed (84.4% versus 78.5%, P = 0.035). Independent predictors of long-term RA graft failure included proximal stenosis of target right coronaries < 90% (OR = 2.35, 95%CI 1.41-5.82) and diabetes mellitus (OR = 1.66, 95%CI 1.17-4.26).The RA graft had a superior long-term patency than the SV graft. Long-term patency of the RA graft may be poor in diabetics or in the case of proximal stenosis of target right coronary <90%. (Trial registration: ChiCTR-OCH-1200212).


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/etiologia , Artéria Radial , Veia Safena , Grau de Desobstrução Vascular , Idoso , Estudos de Coortes , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
J Card Surg ; 34(10): 988-993, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31478233

RESUMO

INTRODUCTION: The effect of red blood cell distribution width (RDW) on long-term major cardiac and cardiovascular event (MACCE) in patients with off-pump coronary artery bypass (OPCAB) has not been adequately studied. We investigated the relationship between RDW and the risk of MACCE in patients who underwent OPCAB. METHODS: We retrospectively analyzed the data of 440 consecutive, nonanemic patients (362 males; 82.27% and mean age 60.8 ± 8.9 years) who underwent OPCAB between October 2009 and September 2012 in Fuwai Hospital. Long-term follow-up was obtained through phone calls, hospital records, and clinic visits. MACCE (death, ST elevated infarction, repeat coronary revascularization, stroke) was determined. RESULTS: Over a median of 7.0-year follow-up, 80 incident MACCE events were identified. The RDW levels on admission were significantly higher in MACCE group than non-MACCE group (13.1 ± 0.7 vs 12.8 ± 0.7; P = .005). Using the Cox proportional hazards models, we found that per 1% increment of RDW, the incident of MACCE was increased in different models (hazard ratio [HR] was 1.520, 1.532, and 1.795, respectively; P = .002, .004, and .002). The receiver-operating characteristic analysis revealed an RDW cut-off value of 13% predicting MACCE. Therefore, patients were grouped on this cut-off value. The Kaplan-Meier plot revealed significantly lower event-free survival in the higher RDW group (P = .0158). Compared with subjects in the RDW <13% in full model, subjects in the RDW ≥13% had an HR of 1.829 (95% confidence interval, 1.103-3.032; P = .019). CONCLUSIONS: An RDW level greater than 13% in hospital admission is independently associated with an increased incidence of long-term MACCE after OPCAB.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Eritrócitos/citologia , Complicações Pós-Operatórias/epidemiologia , China/epidemiologia , Doença da Artéria Coronariana/sangue , Contagem de Eritrócitos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
12.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451466

RESUMO

Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism; however, MBD in a non-alcoholic diabetic patient has rarely been reported. The aetiology or pathophysiology of MBD is still unknown. A 50-year-old man with a history of untreated diabetes mellitus underwent on-pump beating coronary artery bypass graft surgery (CABG) surgery for three-vessel and left main coronary disease. 3 days after the surgery, he developed a fever over 40°C and entered a coma state. MRI revealed multiple lesions, including in the corpus callosum, globus pallidus, brain stem and upper cervical spinal cord, which suggested MBD. The patient did not respond to thiamine therapy, but partly responded to steroid therapy. He ultimately died of respiratory failure. The autopsy revealed MBD and haemophagocytic lymphohistiocytosis. It is rare, but systemic inflammatory response syndrome induced by on-pump beating CABG could develop these complication.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Corpo Caloso/diagnóstico por imagem , Linfo-Histiocitose Hemofagocítica , Doença de Marchiafava-Bignami , Complicações Pós-Operatórias , Autopsia/métodos , Encéfalo/diagnóstico por imagem , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Evolução Fatal , Humanos , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Doença de Marchiafava-Bignami/diagnóstico , Doença de Marchiafava-Bignami/etiologia , Doença de Marchiafava-Bignami/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia
13.
Braz J Cardiovasc Surg ; 34(4): 488-490, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454205

RESUMO

Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra-orphan disease. We report the first case in the literature of Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in a patient with paroxysmal nocturnal hemoglobinuria. A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease. The conduits used for coronary revascularization were both internal thoracic arteries (left ITA-right ITA [LITA-RITA]). We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença das Coronárias/cirurgia , Hemoglobinúria Paroxística/complicações , Adulto , Angiografia Coronária/métodos , Doença das Coronárias/complicações , Humanos , Masculino , Artéria Torácica Interna/transplante
14.
J Card Surg ; 34(10): 948-956, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31376213

RESUMO

INTRODUCTION: The advantages of off-pump coronary artery bypass grafting (OPCAB) in octogenarians are still undetermined. METHODS: We retrospectively collected the data of 338 patients aged ≥75 with at least two coronary-artery diseases who underwent OPCAB. Then, the two groups were divided into follow-up survival and follow-up death subgroups. The baseline and perioperative data were compared for the younger and octogenarian groups, as well as for the subgroups. Moreover, long-term survival rates in the follow-up survival and follow-up death subgroups were compared; a Cox regression model was built to explore the independent risk factors that influence long-term survival. RESULTS: NYNA ≥ III (39.4% vs 23.2%, P = .006), AMI (45.1% vs 24.3%, P = .001), and three diseased vessels with LM disease (38.0% vs 25.8%, P = .043) were more prevalent among octogenarians. Octogenarians required more intraoperative (11.3% vs 0.40%, P = .000) and postoperative (9.9% vs 2.2%, P = .003) IABP insertions and more ventilation time (P = .053), and they spent a longer time in the ICU (174.1 ± 34.9 vs 81.0 ± 6.4 hours, P = .010), had a longer total hospital stay (32.7 ± 3.1 vs 24.6 ± 0.8 days, P = .015), and had a longer postoperative hospital stay (20.5 ± 2.5 vs 14.5 ± 0.7 days, P = .021); however, fewer LIMA grafts were used among octogenarians (71.8% vs 90.3%, P = .000). The mortality and the postoperative complications between the two groups were similar. Long-term survival at 1, 5, and 10 years were satisfactory at 98.4 vs 91.5%, 89.7 vs 82.8%, and 61.1 vs 52.1% for the younger group and the octogenarians, respectively (P = .440). The Cox regression analysis results suggest that malignant ventricular arrhythmias (HR 4.058, CI, 1.760-9.358, P = .001; HR 7.256, CI, 2.112-24.932, P = .001) and reintubation (HR 3.593, CI, 1.646-7.845, P = .001; HR 4.252, CI, 1.797-10.060, P = .001) were independent risk factors that affect the long-term survival in both overall OPCAB patients and in the younger patient group. CONCLUSIONS: OPCAB can be safely performed, with acceptable operative mortality and complication rates and satisfactory survival outcomes. The Cox regression analysis results demonstrated that malignant ventricular arrhythmia and reintubation were independent risk factors that affect long-term survival in both overall OPCAB patients and in the younger group of patients.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Previsões , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
15.
J Am Coll Cardiol ; 74(6): 729-740, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31395122

RESUMO

BACKGROUND: Concerns remain for a greater risk of incomplete revascularization and reduced survival with off-pump coronary artery bypass grafting (CABG) surgery compared with on-pump surgery particularly in patients with left main disease and extensive underlying myocardial ischemia. OBJECTIVES: This study sought to compare outcomes following off-pump versus on-pump surgery for left main disease by performing a post hoc analysis from the multicenter, randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: The EXCEL trial was designed to compare percutaneous coronary intervention with everolimus-eluting stents versus CABG in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-pump vs. off-pump surgery) according to the discretion of the operator. The 3-year outcomes in the off-pump and on-pump groups were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. RESULTS: Among 923 CABG patients, 652 and 271 patients underwent on-pump and off-pump surgery, respectively. Despite a similar extent of disease, off-pump surgery was associated with a lower rate of revascularization of the left circumflex coronary artery (84.1% vs. 90.0%; p = 0.01) and right coronary artery (31.1% vs. 40.6%; p = 0.007). After IPTW adjustment for baseline differences, off-pump surgery was associated with a significantly increased risk of 3-year all-cause death (8.8% vs. 4.5%; hazard ratio: 1.94; 95% confidence interval: 1.10 to 3.41; p = 0.02) and a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction, or stroke (11.8% vs. 9.2%; hazard ratio: 1.28; 95% confidence interval: 0.82 to 2.00; p = 0.28). CONCLUSIONS: Among patients with left main disease treated with CABG in the EXCEL trial, off-pump surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-pump surgery.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Idoso , Causas de Morte/tendências , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/mortalidade , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida/tendências , Resultado do Tratamento
16.
Rev. cir. (Impr.) ; 71(4): 299-306, ago. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1058276

RESUMO

INTRODUCCIÓN: La cirugía sin circulación extracorpórea (CEC) es una variante de la técnica convencional. Existe controversia sobre sus beneficios, seguridad y resultados a largo plazo. OBJETIVO: Describir resultados inmediatos y alejados (a 5 años) de cirugía sin CEC y compararlos a cirugía con CEC. MATERIALES y MÉTODOS: Estudio descriptivo-analítico, con revisión de base de datos del equipo, protocolos quirúrgicos, fichas clínicas, seguimiento clínico y/o entrevista telefónica y en registro civil de pacientes operados entre enero de 2006 y diciembre de 2008. Total 658 cirugías coronarias aisladas, 466 (70,8%) con CEC y 192 (29,2%) sin CEC. Se realizó técnica de Propensity Score Matching para identificar grupos de pacientes similares y comparar resultados entre ambas técnicas. RECSULTADOS: Mortalidad operatoria en 1,0% en el grupo sin CEC y 2,1% en el grupo con CEC (p = 0,411). En seguimiento alejado: Supervivencia a 1, 3 y 5 años de 97,4%, 95,3% y 92,2% respectivamente sin CEC vs 97,9%, 96,3% y 92,7% respectivamente con CEC (p = 0,824). Mayor-Adverse-Cardiac-and-Cerebrovascular-Events (MACCE) 28 (17,3%) sin CEC vs 26 (16,0%) (p = 0,71). Infarto agudo al miocardio (IAM) 3 (1,9%) sin CEC vs 6 (3,7%) (p = 0,33), accidente vascular encefálico (AVE) 6 (3,7%) sin CEC vs 3 (1,9%) (p = 0,3) y reintervención 4 (2,5%) sin CEC vs 3 (1,9%) (p = 0,703). Recurrencia de angina 9 (5,6%) sin CEC vs 10 (6,2%) (p = 0,813). CONCLUSIONES: En nuestra serie de paciente ambas técnicas fueron comparables en resultados inmediatos y alejados.


INTRODUCTION: Coronary artery bypass grafting (CABG) without extracorporeal circulation (off pump) is a technical alternative to conventional surgery. There is ongoing controversy about its benefits, safety and results. AIM: To describe immediate and late results of off pump CABG and compare it with conventional surgery. MATERIALS AND METHOD: Descriptive-analytic, study with review of surgical protocols, clinical charts, civil registry for survival and telephonic follow up of patient who underwent CABG in our center between January 2006 and December 2008. In total 658 isolated CABG cases, 466 (70.8%) on pump and 192 (29.2%) off pump. A Propensity Score Matching was used to match off pump CABG patients with those undergoing On Pump CABG. RESULTS: Mortality was 1.0% in off pump and 2.1% in on pump patients (p = 0.411). At follow up: 1.3 and 5 year survival was 97.4%, 95.3% and 92.2% respectively in off pump patients and 97.9%, 96.3% and 92.7% respectively in On Pump patients (p = 0.824). Mayor-adverse-Cardiac-and-Cerebrovascular-events (MACCE) in 28 (17.3%) off pump vs 26 (16.0%) (p = 0.71) on pump, myocardial infarction in 3 (1.9%) off pump vs 6 (3.7%) on pump (p = 0.33), stroke in 6 (3.7%) off pump vs 3 (1.9%) on pump (p = 0.3) and coronary reintervention in 4 (2.5%) off pump vs 3 (1.9%) on pump patients (p = 0.703). Recurrence of angina in 9 (5.6%) off pump vs 10 (6.2%). CONCLUSIONS: In our experience both techniques had similar results.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença das Coronárias/cirurgia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Pontuação de Propensão , Análise de Sobrevida , Entrevistas como Assunto , Seguimentos , Resultado do Tratamento , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Circulação Extracorpórea , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidade
17.
Braz J Cardiovasc Surg ; 34(3): 311-317, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310470

RESUMO

OBJECTIVE: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. METHODS: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. RESULTS: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). CONCLUSION: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/fisiopatologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/psicologia , Eletrocardiografia/psicologia , Lorazepam/uso terapêutico , Cuidados Pré-Operatórios/métodos , Adolescente , Adulto , Idoso , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/psicologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Gen Thorac Cardiovasc Surg ; 67(9): 736-741, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256329

RESUMO

Data on isolated coronary artery bypass grafting (CABG) performed in 2015 and 2016, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 55.0% (n = 16,173) of all CABG cases (n = 29,392), and graft material for the LAD was positioned at the internal thoracic artery in 72.1% and at the right internal thoracic artery in 17.4% of patients. Operative mortality was 1.7% in elective cases, 8.8% in emergency cases, and 3.0% overall, which was similar to our previous report. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 2.5% for on-pump CABG, and all morbidities except for "readmission < 30 days" were significantly better in OPCAB cases.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiologia/métodos , Cardiologia/tendências , Ponte de Artéria Coronária/tendências , Ponte de Artéria Coronária sem Circulação Extracorpórea/tendências , Vasos Coronários/cirurgia , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Feminino , Humanos , Japão , Masculino , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade , Morbidade , Estudos Retrospectivos , Resultado do Tratamento
19.
Georgian Med News ; (290): 17-20, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322507

RESUMO

Our aim was to compare early post-operative period of Endo-ACAB with OPCABG. We retrospectively studied 760 cases of all patients who had underwent urgent or planned coronary artery bypass grafting at the "Tbilisi Heart and Vascular Clinic" from November 2015 till November 2017. Patients were divided into two group: first group patients who had underwent Endo-ACAB and second group patients who had underwent OPCABG. Early postoperative complications including pneumonia, stroke, ventricular fibrillation, pain intensity, wound infection and hospital stay were studied. After analyzing both groups of the patients we concluded that no statistically significant difference was revealed in presence of preoperative risk-factors like diabetes mellitus and arterial hypertension between the study groups. Mean ejection fraction was slightly lower in Endo-ACAB group but statistical analysis showed no significant difference. Moreover, no statistical difference was seen in early postoperative complications like pneumonia, stroke, ventricular fibrillation or early mortality. Respectively severely of pain was similar in Endo-ACAB group compared with CABG. Statistical analyses revealed significant lower rate of surgical wound complication and hospital stay in Endo-ACAB group. In both group no intraoperative mortality was detected. To conclude Endo-ACAB has significantly lower rate of early postoperative complications compared to OPCABG according to the date of "Tbilisi Heart and Vascular Clinic".


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Georgia/epidemiologia , Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
20.
J Card Surg ; 34(7): 638-640, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212360

RESUMO

A The coronary artery bypass graft (CABG) is common. Sometimes can be challenging. Here we present a 79-year-old man presented with unstable angina and simultaneous activelower gastrointestinal bleeding (hemoglobin level, 5.1 g/L) due to actinic rectitis after radiation therapy for prostate carcinoma performed 1 year previously. Coronary angiography showed marked stenosis of the left anterior descending artery. Antiplatelet aggregation therapy, such as percutaneous coronary intervention or systemic heparin therapy for coronary artery bypass, was not feasible owing to the active rectal bleeding. Therefore, off-pump CABG has performed without systemic heparin therapy and the patient recovered well. For specific cases, CABG without systemic heparin therapy can be safely performed.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Hemorragia Gastrointestinal/complicações , Infarto do Miocárdio/cirurgia , Doenças Retais/complicações , Idoso , Heparina , Humanos , Masculino , Infarto do Miocárdio/complicações , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA