RESUMO
El propósito del presente trabajo fue comparar las características clínicas y resultados hospitalarios de pacientes (P) diabéticos (DBT) y no DBT sometidos a cirugía coronaria (CC) pura. Secundariamente se compararon los resultados de la cirugía con injerto único y doble de arterias mamarias internas en DBT y no DBT. Se analizaron los datos de 4955 pacientes sometidos a CC pura...En la presente serie se demostró que los P DBT sometidos a CC constituyen una población de mayor riesgo porque presentan frecuentemente otras comorbilidades asociadas y una mayor extensión de enfermedad ateroesclerótica. Aunque ellos no presentaron mayor mortalidad sí observaron una frecuencia mayor de complicaciones postoperatorias no fatales. El uso doble injerto con arterias mamarias en DBT no le confiere riesgos adicionales al procedimiento
Assuntos
Adulto , Estudo Comparativo , Revascularização Miocárdica , Diabetes Mellitus , Fatores de Risco , Complicações Pós-Operatórias , Artéria Torácica InternaRESUMO
El propósito del presente trabajo fue comparar las características clínicas y resultados hospitalarios de pacientes (P) diabéticos (DBT) y no DBT sometidos a cirugía coronaria (CC) pura. Secundariamente se compararon los resultados de la cirugía con injerto único y doble de arterias mamarias internas en DBT y no DBT. Se analizaron los datos de 4955 pacientes sometidos a CC pura...En la presente serie se demostró que los P DBT sometidos a CC constituyen una población de mayor riesgo porque presentan frecuentemente otras comorbilidades asociadas y una mayor extensión de enfermedad ateroesclerótica. Aunque ellos no presentaron mayor mortalidad sí observaron una frecuencia mayor de complicaciones postoperatorias no fatales. El uso doble injerto con arterias mamarias en DBT no le confiere riesgos adicionales al procedimiento
Assuntos
Adulto , Diabetes Mellitus , Artéria Torácica Interna , Revascularização Miocárdica , Complicações Pós-Operatórias , Fatores de RiscoRESUMO
BACKGROUND: Taking into account the steady increase in the number of elderly patients requiring coronary artery bypass grafting, we sought to analyze the in-hospital and long-term evolution of a group of elderly patients (>/= 75 years) who underwent coronary artery bypass grafting, and to identify clinical predictors of mortality and long-term symptoms. METHODS: Between April 1996 and February 2000, 207 patients older than 75 years of age who had undergone coronary bypass grafting were prospectively and consecutively analyze. Mean age was 78.4 +/- 2.7. RESULTS: An average of 2.6 grafts/patients was constructed. Left mammary artery was used in 93% of patients. The in-hospital incidence of heart failure, atrial fibrillation, preoperative infarction and stroke was 38%, 29%, 4.8% and 2.8% respectively. The in-hospital mortality rate was 5.8%. Mean follow-up was 18 months (25th an 75th percentiles 9-29). Late mortality rate was 4.1% in eight patients. Excluding the in-hospital deaths, the estimated probability of survival (Kaplan-Meier) at 3 years was 94% and the survival freedom from symptoms was 86%. A multivariate analysis showed that only age was predictor of in-hospital mortality (OR 1.16, p = 0.009). Only peripheral vascular disease was found as a predictor of symptoms during the long-term follow-up (p = 0.001). CONCLUSIONS: In this series of senile patients who underwent coronary surgery, those of an older age (> 80 years) showed a higher risk of in-hospital mortality. The presence of peripheral vascular disease is useful in the prognosis assessment of the group.
Assuntos
Doença das Coronárias/cirurgia , Revascularização Miocárdica , Fatores Etários , Idoso , Feminino , Hospitalização , Humanos , Masculino , Revascularização Miocárdica/mortalidade , Estudos Prospectivos , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: Our objective was to determine whether complete myocardial revascularization "off pump" was feasible while maintaining the efficacy of conventional surgical techniques. METHODS: 264 patients were operated on between March 15, 1998, and August 26, 1999. A total of 218 (82.6%) were men and the average age was 61.4 years (range 28 to 87 years). Left main occlusions were present in 10.2% and 84% had multiple vessel disease. A total of 628 grafts were implanted, an average of 2.4 grafts per patient. Total arterial revascularization was achieved in 81.5% using both internal mammary arteries and the radial artery, one or more venous grafts in 18.1%, and venous alone in 0.3%. RESULTS: Surgical mortality was 2.2% and perioperative myocardial infarction was 3%. There were no neurologic events in this group of patients. In the first 73 patients coronary angiography control was performed before discharge and all grafts were patent. Angioplasty was carried out in 2 patients (0.76%) and conversion of procedure in 4 (1.5%). Follow-up time was 4 to 14 months. CONCLUSIONS: This procedure enabled revascularization of all areas of the heart, usually with total arterial revascularization, and excellent patency rates. The morbidity and mortality observed was similar to conventional surgery. The incidence of secondary complications (bleeding, need for transfusion, prolonged mechanical ventilation, or neurologic events) was lower.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Revascularização Miocárdica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/mortalidade , Grau de Desobstrução VascularRESUMO
BACKGROUND: In recent years, minimally invasive direct coronary artery bypass grafting has emerged as a valid tool for revascularization in a select group of patients with severe lesions of the left anterior descending coronary artery. Here we report the clinical results using two devices designed by us to facilitate the harvesting of the left internal mammary artery up to its origin and to occlude and stabilize the left anterior descending coronary artery while placing the anastomosis. METHODS: From January 1996 to January 1998, 122 patients underwent minimally invasive direct coronary artery bypass grafting in the Department of Cardiac Surgery, Favaloro Foundation. One hundred twelve patients received a single left internal mammary artery-left anterior descending coronary artery bypass graft, and in 10 patients, an additional bypass graft was performed. RESULTS: Most patients were discharged on day 2 or 3 after the procedure. Three patients (2.5%) had a perioperative myocardial infarction. The overall hospital mortality rate was 3.3% (4 patients). CONCLUSIONS: The combination of team experience, more careful dissection of the left internal mammary artery up to its origin, and use of the stabilizer-occluder and interrupted suture technique for the anastomosis has markedly improved our results.
Assuntos
Ponte de Artéria Coronária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Ponte de Artéria Coronária/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Análise de Sobrevida , Técnicas de Sutura , Toracotomia/métodosRESUMO
BACKGROUND: We analyzed in-hospital results of 87 patients undergoing minimally invasive valvular operations (right parasternal incision through third and fourth cartilages). METHODS: Age was 21 to 84 years (mean, 56.2 +/- 16); 45 patients (51.7%) were female. Five (5.7%) had a previous valvular operation and 8 (9.2%) had severe left ventricular dysfunction. Valve diseases were as follows: aortic in 35 patients (40.2%), mitral in 44 (50.5%), double in 5 (5.7%), tricuspid regurgitation in 2 (2.2%), and mitral periprosthetic leak in 1 (1.1%). RESULTS: Nineteen mitral repairs (21.9%), 22 replacements (25.3%), 1 leak closure (1.1%), 1 tricuspid repair (1.1%), and 1 replacement (1.1%) were performed. Thirty-one patients (35.7%) underwent aortic replacement, 2 (2.3%) aortic decalcification, 1 (1.1%) subaortic membrane resection, 4 (4.6%) a double-valve procedure, and 5 (5.7%) a single-valve operation combined with myocardial revascularization. In-hospital mortality was 5.7% (5 patients). Univariate analysis was significant for previous operation, New York Heart Association class IV and severe ventricular dysfunction. Multivariate analysis was significant for previous operation and severe ventricular dysfunction. Atrial fibrillation (12.6%) was the most frequent complication. Postoperative stay was 6.5 +/- 6 days. CONCLUSIONS: The minimally invasive approach is a useful technique in valvular surgery. Patients with a previous valvular operation, severe ventricular dysfunction, and New York Heart Association class IV dyspnea have higher in-hospital mortality.
Assuntos
Doenças das Valvas Cardíacas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Doenças das Valvas Cardíacas/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do TratamentoRESUMO
El objetivo de este estudio fue evaluar los resultados de la cirugía de revascularización miocárdica y el trasplante cardíaco ortotópico en pacientes con cardiomiopatía isquémica y fracción de eyección de ventrículo izquierdo menor o igual 25 por ciento. Noventa y cuatro pacientes, con edad media de 55,4 ñ 20 años (27-74), 87 (92 por ciento) de sexo masculino, fueron evaluados por el Servicio de Trasplante e Insuficiencia Cardíaca. Se analizaron dos grupos: 48 pacientes (51 por ciento) pertenecientes al grupo de cirugía de revascularización miocárdica y 46 (49 por ciento) al grupo de trasplante cardíaco ortotópico (17 por ciento, 8 pacientes; p= 0,09). No hubo diferencias en la mortalidad hospitalaria y la supervivencia a 3 años en ambos grupos. Ambos métodos mejoraron la clase funcional de disnea y la función ventricular izquierda. La cirugía de revascularización miocárdica debería ser considerada el método de primera elección. Los pacientes con pobre clase funcional de disnea, mayor diámetro diastólico de ventrículo izquierdo y menor fracción de eyección no son buenos candidatos para la revascularización miocárdica. La cantidad de territorios viables predijo la mejoría de la función ventricular (AU)
Assuntos
Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Isquemia Miocárdica/cirurgia , Revascularização Miocárdica/mortalidade , Transplante de Coração , Mortalidade Hospitalar , Função Ventricular/fisiologia , Análise MultivariadaRESUMO
El objetivo de este estudio fue evaluar los resultados de la cirugía de revascularización miocárdica y el trasplante cardíaco ortotópico en pacientes con cardiomiopatía isquémica y fracción de eyección de ventrículo izquierdo menor o igual 25 por ciento. Noventa y cuatro pacientes, con edad media de 55,4 ñ 20 años (27-74), 87 (92 por ciento) de sexo masculino, fueron evaluados por el Servicio de Trasplante e Insuficiencia Cardíaca. Se analizaron dos grupos: 48 pacientes (51 por ciento) pertenecientes al grupo de cirugía de revascularización miocárdica y 46 (49 por ciento) al grupo de trasplante cardíaco ortotópico (17 por ciento, 8 pacientes; p= 0,09). No hubo diferencias en la mortalidad hospitalaria y la supervivencia a 3 años en ambos grupos. Ambos métodos mejoraron la clase funcional de disnea y la función ventricular izquierda. La cirugía de revascularización miocárdica debería ser considerada el método de primera elección. Los pacientes con pobre clase funcional de disnea, mayor diámetro diastólico de ventrículo izquierdo y menor fracción de eyección no son buenos candidatos para la revascularización miocárdica. La cantidad de territorios viables predijo la mejoría de la función ventricular