RESUMEN
PURPOSE: To compare the blood flow in the internal thoracic artery when dissected endoscopically in a conventional manner, in addition to develop a reliable experimental training model for the surgical team. METHODS: Paired experimental study. Ten pigs were operated and had both internal thoracic arteries dissected, the right with a conventional technique and the left by video endoscopy. The main outcomes to be studied were flow, length, and time of dissection of each vessel. RESULTS: Blood flow measurements were performed with mean heart rate of 100 ± 16 bpm and mean arterial pressure of 89.7 ± 13 mm Hg. The mean blood flow of endoscopic dissection of the internal thoracic artery was 170.2 ± 66.3 mL/min and by direct view was 180.8 ± 70.5 (p = 0.26). Thus, there was no statistically significant difference between the flows, showing no inferiority between the methods. CONCLUSIONS: The minimally invasive dissection of the internal thoracic artery was shown to be not inferior to the dissection by open technique in relation to the blood flow in the present experimental model. In addition, the model that we replicated was shown to be adequate for the development of the learning curve and improvement of the endoscopic abilities.
Asunto(s)
Arterias Mamarias , Animales , Disección , Endoscopía , Hemodinámica , Arterias Mamarias/cirugía , PorcinosRESUMEN
ABSTRACT Purpose: To compare the blood flow in the internal thoracic artery when dissected endoscopically in a conventional manner, in addition to develop a reliable experimental training model for the surgical team. Methods: Paired experimental study. Ten pigs were operated and had both internal thoracic arteries dissected, the right with a conventional technique and the left by video endoscopy. The main outcomes to be studied were flow, length, and time of dissection of each vessel. Results: Blood flow measurements were performed with mean heart rate of 100 ± 16 bpm and mean arterial pressure of 89.7 ± 13 mm Hg. The mean blood flow of endoscopic dissection of the internal thoracic artery was 170.2 ± 66.3 mL/min and by direct view was 180.8 ± 70.5 (p = 0.26). Thus, there was no statistically significant difference between the flows, showing no inferiority between the methods. Conclusions: The minimally invasive dissection of the internal thoracic artery was shown to be not inferior to the dissection by open technique in relation to the blood flow in the present experimental model. In addition, the model that we replicated was shown to be adequate for the development of the learning curve and improvement of the endoscopic abilities.
Asunto(s)
Animales , Arterias Mamarias/cirugía , Porcinos , Disección , Endoscopía , HemodinámicaRESUMEN
Abstract Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients' groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Complicaciones Posoperatorias/prevención & control , Transfusión Sanguínea/estadística & datos numéricos , Cuidados Intraoperatorios/efectos adversos , Estudios Prospectivos , Factores de Riesgo , Medición de Riesgo , Procedimientos Quirúrgicos Torácicos , Reacción a la TransfusiónRESUMEN
OBJECTIVE: to describe, in a practical and step-by-step manner, the construction of a fully electronic platform for data collection, storage, and analysis, initially proposed for cardiovascular surgery, with interfaces that are reproducible and applicable to other surgical specialties, as well as to present the initial work experience with this instrument in cardiac surgery and the preliminary results obtained after its implementation in a Brazilian tertiary university hospital. METHODS: the platform was developed based on Google tools, which are free, easy to use, and widely accessible. From the beginning of this initiative, in May 2015, to the preliminary analysis, in February 2017, data from 271 consecutive patients submitted to cardiovascular surgery were prospectively recorded and preliminarily analyzed. RESULTS: the initiative was implemented with full success, with 100% of patients included and without loss of any variable, in a database composed of more than 500 variables. The most frequent immediate postoperative complications were: atrial fibrillation (22.5%), bronchopneumonia (10.7%), delirium (10.3%), acute renal failure (10%), stroke (5%), and death (7%). Comparing mortality rates in the first and second years of the initiative, a reduction from 10.8% to 4% (p=0.042), respectively, was evidenced. CONCLUSION: the new proposal of data collection and storage presented in this work was fully feasible and effective. It may be useful to other surgical specialties that wish to develop methods to evaluate success and postoperative complication rates, as well as quality improvement programs.
OBJETIVO: descrever de maneira prática e detalhada a criação de uma plataforma totalmente informatizada para coleta, armazenamento e análise de dados, inicialmente proposta para cirurgia cardiovascular, com interfaces reprodutíveis e aplicáveis a outras especialidades cirúrgicas, bem como, apresentar a experiência inicial de trabalho com esta ferramenta e os resultados preliminares obtidos após sua implementação em um hospital universitário terciário brasileiro. MÉTODOS: a plataforma foi desenvolvida com base nas ferramentas Google, gratuitas, de fácil utilização e amplamente acessíveis. Desde o início desta iniciativa, em maio de 2015, até a análise preliminar, em fevereiro de 2017, dados de 271 pacientes, consecutivos, submetidos à cirurgia cardiovascular foram prospectivamente recordados e analisados. RESULTADOS: a iniciativa foi implementada com pleno sucesso, com 100% dos pacientes incluídos e sem perda de qualquer variável em um banco de dados composto por mais de 500 variáveis. As complicações pós-operatórias imediatas mais frequentes foram: fibrilação atrial (22,5%), broncopneumonia (10,7%), delirium (10,3%), insuficiência renal aguda (10%), acidente vascular encefálico (5%) e morte (7%). Comparando-se as taxas de mortalidade no primeiro e segundo anos da iniciativa, uma redução de 10,8% para 4% (p=0,042), respectivamente, foi evidenciada. CONCLUSÃO: a nova proposta de coleta e armazenamento de dados apresentada neste trabalho mostrou-se plenamente factível e efetiva. Por serem gratuitas, de fácil manuseio e universalmente acessíveis, estas ferramentas podem ser úteis a outras especialidades cirúrgicas que desejem desenvolver métodos de avaliação de sucesso e complicações pós-operatórios, bem como, programas de melhoria de qualidade.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Bases de Datos Factuales/normas , Formularios como Asunto , Programas Informáticos/normas , Anciano , Brasil , Femenino , Hospitales Universitarios , Humanos , Internet , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Mejoramiento de la Calidad , Reproducibilidad de los ResultadosRESUMEN
RESUMO Objetivo: descrever de maneira prática e detalhada a criação de uma plataforma totalmente informatizada para coleta, armazenamento e análise de dados, inicialmente proposta para cirurgia cardiovascular, com interfaces reprodutíveis e aplicáveis a outras especialidades cirúrgicas, bem como, apresentar a experiência inicial de trabalho com esta ferramenta e os resultados preliminares obtidos após sua implementação em um hospital universitário terciário brasileiro. Métodos: a plataforma foi desenvolvida com base nas ferramentas Google, gratuitas, de fácil utilização e amplamente acessíveis. Desde o início desta iniciativa, em maio de 2015, até a análise preliminar, em fevereiro de 2017, dados de 271 pacientes, consecutivos, submetidos à cirurgia cardiovascular foram prospectivamente recordados e analisados. Resultados: a iniciativa foi implementada com pleno sucesso, com 100% dos pacientes incluídos e sem perda de qualquer variável em um banco de dados composto por mais de 500 variáveis. As complicações pós-operatórias imediatas mais frequentes foram: fibrilação atrial (22,5%), broncopneumonia (10,7%), delirium (10,3%), insuficiência renal aguda (10%), acidente vascular encefálico (5%) e morte (7%). Comparando-se as taxas de mortalidade no primeiro e segundo anos da iniciativa, uma redução de 10,8% para 4% (p=0,042), respectivamente, foi evidenciada. Conclusão: a nova proposta de coleta e armazenamento de dados apresentada neste trabalho mostrou-se plenamente factível e efetiva. Por serem gratuitas, de fácil manuseio e universalmente acessíveis, estas ferramentas podem ser úteis a outras especialidades cirúrgicas que desejem desenvolver métodos de avaliação de sucesso e complicações pós-operatórios, bem como, programas de melhoria de qualidade.
ABSTRACT Objective: to describe, in a practical and step-by-step manner, the construction of a fully electronic platform for data collection, storage, and analysis, initially proposed for cardiovascular surgery, with interfaces that are reproducible and applicable to other surgical specialties, as well as to present the initial work experience with this instrument in cardiac surgery and the preliminary results obtained after its implementation in a Brazilian tertiary university hospital. Methods: the platform was developed based on Google tools, which are free, easy to use, and widely accessible. From the beginning of this initiative, in May 2015, to the preliminary analysis, in February 2017, data from 271 consecutive patients submitted to cardiovascular surgery were prospectively recorded and preliminarily analyzed. Results: the initiative was implemented with full success, with 100% of patients included and without loss of any variable, in a database composed of more than 500 variables. The most frequent immediate postoperative complications were: atrial fibrillation (22.5%), bronchopneumonia (10.7%), delirium (10.3%), acute renal failure (10%), stroke (5%), and death (7%). Comparing mortality rates in the first and second years of the initiative, a reduction from 10.8% to 4% (p=0.042), respectively, was evidenced. Conclusion: the new proposal of data collection and storage presented in this work was fully feasible and effective. It may be useful to other surgical specialties that wish to develop methods to evaluate success and postoperative complication rates, as well as quality improvement programs.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Procedimientos Quirúrgicos Cardiovasculares , Programas Informáticos/normas , Bases de Datos Factuales/normas , Formularios como Asunto , Evaluación de Procesos y Resultados en Atención de Salud , Brasil , Reproducibilidad de los Resultados , Internet , Mejoramiento de la Calidad , Hospitales Universitarios , Persona de Mediana EdadRESUMEN
We describe herein a case of a patient who, when in orthostatic positions, had severe hypoxemia and ventilatory dysfunction. Although the severity of symptoms required hospitalization in an intensive care setting, the initial tests only identified the presence of enlarged aortic root, which did not explain the condition. The association of these events with an unusual etiology, namely intracardiac shunt, characterized the diagnosis of platypnea-orthodeoxia syndrome. The literature review shows that, with advancing research methods, there was a progressive increase in the identification of this condition, and this association should be part of the differential diagnosis of dyspnea in patients with enlarged aortic root.
Asunto(s)
Enfermedades de la Aorta/complicaciones , Disnea/etiología , Hipoxia/etiología , Anciano de 80 o más Años , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/patología , Cuidados Críticos , Diagnóstico Diferencial , Disnea/diagnóstico , Femenino , Humanos , Hipoxia/diagnóstico , Postura , Índice de Severidad de la EnfermedadRESUMEN
Descrevemos aqui o caso de um paciente que, ao assumir posições de ortostatismo, apresentava hipoxemia e disfunção ventilatória grave. Embora a gravidade dos sintomas tenha determinado a necessidade de internação em ambiente de terapia intensiva, os exames iniciais identificaram apenas a presença de ectasia da aorta, sem, no entanto, justificar o quadro. A associação dessas manifestações a uma etiologia incomum, o shunt intracardíaco, caracterizou o diagnóstico da síndrome de platipneia-ortodeóxia. A revisão da literatura demonstra que, com o avanço dos métodos de investigação, houve progressivo aumento na identificação desse quadro, devendo essa associação fazer parte do diagnóstico diferencial de dispneia em pacientes com aorta ectásica.
We describe herein a case of a patient who, when in orthostatic positions, had severe hypoxemia and ventilatory dysfunction. Although the severity of symptoms required hospitalization in an intensive care setting, the initial tests only identified the presence of enlarged aortic root, which did not explain the condition. The association of these events with an unusual etiology, namely intracardiac shunt, characterized the diagnosis of platypnea-orthodeoxia syndrome. The literature review shows that, with advancing research methods, there was a progressive increase in the identification of this condition, and this association should be part of the differential diagnosis of dyspnea in patients with enlarged aortic root.
Asunto(s)
Anciano de 80 o más Años , Femenino , Humanos , Hipoxia/etiología , Enfermedades de la Aorta/complicaciones , Disnea/etiología , Hipoxia/diagnóstico , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/patología , Cuidados Críticos , Diagnóstico Diferencial , Disnea/diagnóstico , Postura , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: This study aims to compare hospital mortality rate of surgical debridement followed by primary wound closure versus surgical debridement with closure after preconditioning of the wound. METHODS: A historical cohort of 43 patients with postoperative mediastinitis type III and IV between 2000 and 2008. The diagnosis of mediastinitis was based on physical examination and laboratory tests. Patients were divided into two groups: patients who received the protocol of preconditioning of the wound (Group 2) and those who did not (Group 1). RESULTS: Of the 43 patients, 15 received the protocol and were assigned to Group 2, and 28 patients to Group 1. Myocardial revascularisation was the surgical intervention most affected by infection, accounting for 69.8% of patients in Group 1 and 64.3% in Group 2.Staphylococcus aureus was the predominant pathogen, accounting for 58.1% of all cases, 50% in Group 1 and 73.3% in Group 2. Hospital mortality rate was 42.9% in Group 1 and 20% in Group 2 (P=1.86), with relative risk of 2.14 and CI [0.714-6.043]. Among the 28 (65.1%) patients who underwent single-stage surgical approach, 12 (27.9%) underwent primary wound closure with irrigation, seven (16.3%) only primary closure, six (14%) omental flap, and three (7%) pectoralis muscle flap. CONCLUSION: Due to the lack of established guidelines, the choice of the surgical approach is based largely on low-level evidence references. Preconditioning of the wound appears to lead to a reduction in mortality in these patients, being a good surgical option.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/mortalidad , Desbridamiento/métodos , Mediastinitis/mortalidad , Técnicas de Cierre de Heridas/mortalidad , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Mediastinitis/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Reproducibilidad de los Resultados , Factores de Riesgo , Infección de la Herida Quirúrgica/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aims to compare hospital mortality rate of surgical debridement followed by primary wound closure versus surgical debridement with closure after preconditioning of the wound. METHODS: A historical cohort of 43 patients with postoperative mediastinitis type III and IV between 2000 and 2008. The diagnosis of mediastinitis was based on physical examination and laboratory tests. Patients were divided into two groups: patients who received the protocol of preconditioning of the wound (Group 2) and those who did not (Group 1). RESULTS: Of the 43 patients, 15 received the protocol and were assigned to Group 2, and 28 patients to Group 1. Myocardial revascularisation was the surgical intervention most affected by infection, accounting for 69.8% of patients in Group 1 and 64.3% in Group 2.Staphylococcus aureus was the predominant pathogen, accounting for 58.1% of all cases, 50% in Group 1 and 73.3% in Group 2. Hospital mortality rate was 42.9% in Group 1 and 20% in Group 2 (P=1.86), with relative risk of 2.14 and CI [0.714-6.043]. Among the 28 (65.1%) patients who underwent single-stage surgical approach, 12 (27.9%) underwent primary wound closure with irrigation, seven (16.3%) only primary closure, six (14%) omental flap, and three (7%) pectoralis muscle flap. CONCLUSION: Due to the lack of established guidelines, the choice of the surgical approach is based largely on low-level evidence references. Preconditioning of the wound appears to lead to a reduction in mortality in these patients, being a good surgical option.
OBJETIVO: Este estudo tem por objetivo comparar a taxa de mortalidade intra-hospitalar do debridamento cirúrgico seguido de fechamento da ferida operatória, com a do debridamento cirúrgico com fechamento após pré-condicionamento da ferida. MÉTODOS: Coorte histórica composta por 43 pacientes portadores de mediastinite pós-operatória tipo III e IV entre os anos de 2000 e 2008. O diagnóstico de mediastinite foi feito com base em exames físico e laboratoriais. Os pacientes foram divididos em dois grupos, os que seguiram o protocolo de pré-condicionamento da ferida operatória (Grupo 2) ou não (Grupo 1). RESULTADOS: Dos 43 pacientes, 15 seguiram o protocolo e foram alocados no Grupo 2. A revascularização do miocárdio foi a cirurgia mais afetada pela infecção, sendo responsável por 69,8% dos pacientes no Grupo 1 e 64,3% no Grupo 2. O Staphylococcus aureus foi o germe mais prevalente, sendo responsável por 58,1% do total dos casos, sendo 50% e 73,3%, respectivamente, nos Grupos 1 e 2. A mortalidade intra-hospitalar foi de 42,9% no Grupo 1 e de 20% no Grupo 2 (P=1,86), com risco relativo de 2,14 e IC [0,714-6,043]. Entre os 28 (65,1%) pacientes do estudo que seguiram a abordagem cirúrgica em um único tempo, 12 (27,9%) foram submetidos a fechamento primário com irrigação, sete (16,3%), a fechamento primário isolado, seis (14%), rotação de retalho de epíplon, e três (7%), interposição de retalho de músculo peitoral. CONCLUSÃO: Na ausência de uma diretriz bem estabelecida, a escolha do tipo de intervenção cirúrgica é feita utilizando-se referências com baixo nível de evidência. O pré-condicionamento da ferida operatória parece levar a redução da mortalidade nesses pacientes, sendo uma boa alternativa cirúrgica.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Cardíacos/mortalidad , Desbridamiento/métodos , Mediastinitis/mortalidad , Técnicas de Cierre de Heridas/mortalidad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Mortalidad Hospitalaria , Mediastinitis/etiología , Complicaciones Posoperatorias/mortalidad , Reproducibilidad de los Resultados , Factores de Riesgo , Infección de la Herida Quirúrgica/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level. METHODS: Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A--eight patients receiving cardioplegia without procaine; group B--ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st--before ischemic arrest, 2nd--at the end of ischemic arrest, and 3rd--15 minutes after reperfusion. RESULTS: The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 +/- 0.2; 0.4 +/- 0.3; 0.4 +/- 0.4, and group B 0.2 +/- 0.2; 0.4 +/- 0.3; 0.7 +/- 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024). CONCLUSION: Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added.
Asunto(s)
Válvula Aórtica/cirugía , Soluciones Cardiopléjicas/farmacología , Enfermedades de las Válvulas Cardíacas/cirugía , Daño por Reperfusión Miocárdica/prevención & control , Miocardio/ultraestructura , Procaína/farmacología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/farmacología , Distribución de Chi-Cuadrado , Soluciones Cristaloides , Femenino , Paro Cardíaco Inducido/métodos , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Soluciones Isotónicas/farmacología , Masculino , Persona de Mediana Edad , Miocardio/enzimología , Remisión Espontánea , Factores de Tiempo , Adulto JovenRESUMEN
OBJETIVO: Avaliar as alterações ultra-estruturais de dois tipos de cardioplegia (com e sem procaína) em corações de pacientes submetidos a troca valvar aórtica eletiva. MÉTODOS: Foram estudados 18 pacientes submetidos a circulação extracorpórea para troca valvular aórtica eletiva, no Hospital de Clínicas de Porto Alegre num período de 10 meses. Cada paciente foi distribuído aleatoriamente em dois grupos: grupo A - oito pacientes que receberam solução cardioplégica sem procaína; grupo B - Dez pacientes que receberam solução cardioplégica com procaína. Em ambos os grupos, o saco pericárdico foi irrigado com solução salina hipotérmica. As biópsias miocárdicas foram realizadas em três momentos: I - antes da parada isquêmica, II- no final do período isquêmico e III-15 minutos após a reperfusão. RESULTADOS: A avaliação ultra-estrutural comparando os grupos nos três momentos não demonstrou diferenças significativas, sendo a média dos escores no grupo A, nos momentos I, II, e III, de 0,1 ± 0,2; 0,4 ± 0,3 e 0,4 ± 0,4. No grupo B, a médio dos escores foi 0,2 ± 0,2; 0,4 ± 0,3 e 0,7 ± 0,2, respectivamente), nos momentos I, II, e III. A curva de CK-MB foi similar entre os dois grupos. O retorno espontâneo do ritmo cardíaco, pós-despinçamento, ocorreu em 70% dos pacientes no grupo B e, em 12,5% no grupo A (p=0,024). CONCLUSÃO: As duas soluções testadas protegeram o miocárdio de forma eficaz e não foi possível demonstrar, em nível ultra-estrutural, a superioridade da solução contendo procaína. Constatou-se que o retorno ao ritmo espontâneo do coração após o despinçamento aórtico foi significativamente maior no grupo que utilizou procaína adicionada à solução.
OBJECTIVE: The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level. METHODS: Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A - eight patients receiving cardioplegia without procaine; group B - ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st - before ischemic arrest, 2nd - at the end of ischemic arrest, and 3rd -15 minutes after reperfusion. RESULTS: The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 ± 0.2; 0.4 ± 0.3; 0.4 ± 0.4, and group B 0.2 ± 0.2; 0.4 ± 0.3; 0.7 ± 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024). CONCLUSION: Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Válvula Aórtica/cirugía , Soluciones Cardiopléjicas/farmacología , Enfermedades de las Válvulas Cardíacas/cirugía , Daño por Reperfusión Miocárdica/prevención & control , Miocardio/ultraestructura , Procaína/farmacología , Anestésicos Locales/farmacología , Distribución de Chi-Cuadrado , Paro Cardíaco Inducido/métodos , Sistema de Conducción Cardíaco/fisiopatología , Soluciones Isotónicas/farmacología , Miocardio/enzimología , Remisión Espontánea , Factores de Tiempo , Adulto JovenRESUMEN
Devido aos baixos índices de permeabilidade dos enxertos de veia safena, a utilizaçäo de artérias como enxerto para revascularizar o miocárdio vem sendo muito testada e tem ganho espaço. A revascularizaçäo da descendente anterior com a artéria torácica interna esquerda é padräo-ouro neste procedimento e é realizada rotineiramente na maioria dos Serviços do mundo há pelo menos 15 anos. Além disso, existem evidências de que o acréscimo de outro enxerto arterial ao tratamento pode diminuir a morbi-mortalidade tanto intra-hospitalar quanto a longo prazo (10 anos). Na escolha do 2º enxerto, a artéria radial tem se destacado com bons índices de permeabilidade a médio prazo (84-92 por cento comparada com safena: 70-80 por cento em 5 anos). O vasoespasmo, fenômeno inerente aos condutos arteriais, ocorre em 5 a 10 por cento dos enxertos de radial. A nitroglicerina e os nitratos säo as drogas mais eficazes no seu controle e os bloqueadores do cálcio näo têm benefício clínico comprovado. Na avaliaçäo da circulaçäo do arco palmar para prevençäo de isquemia do membro operado, o Teste de Allen tem sido satisfatório. Parece razoável, portanto, sugerir a associaçäo de outro enxerto arterial à artéria torácica esquerda na tentativa de melhorar os resultados da CRM e que este enxerto seja a artéria radial