RESUMO
BACKGROUND: Atrial fibrillation (AF) is the most commonly sustained cardiac rhythm disturbance. Surgical ablation techniques were developed involving the left atrium only and modifications of the maze procedure in ablating both atria. OBJECTIVE: The aim of this study was to compare, in patients with permanent AF, the efficacy of uniatrial versus biatrial radiofrequency ablation procedure in the treatment of chronic atrial fibrillation in patients with associated cardiac disease. METHOD: Between September 2003 and May 2009, 30 patients were submitted to the radiofrequency ablation procedure for AF associated with concomitant cardiac surgery; 15 patients underwent a uniatrial procedure, and 15 patients underwent biatrial ablation. The mean age was 47.73 ± 9.85 years, and 53.4% were men. The average followup time was 12.16 ± 10.89 months for the uniatrial group and 7.0 ± 4.0 months for the biatrial group. RESULTS: Neither hospital mortality nor complications related to radiofrequency ablation were was registered. At the time of hospital discharge, 9 patients (60%) were in a state of sinus rhythm in both groups. However, patients undergoing biatrial ablation (range 73.3% versus 46.7%) demonstrated complete freedom from atrial fibrillation at all times. CONCLUSION: Biatrial ablation surgical procedures were more effective in controlling atrial fibrillation than procedures limited to the left atrium.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Veias Pulmonares/cirurgia , Adulto , Antiarrítmicos/uso terapêutico , Antibacterianos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Feminino , Indicadores Básicos de Saúde , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de TempoRESUMO
OBJECTIVE: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. METHODS: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. RESULTS: Postoperative bleeding within first 24 hours (h) period (EACA group 154.66+/-74.64 x Placebo group 220.21+/-136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14+/-420.07 x Placebo group 141.67+/-142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07+/-576.86 x Placebo group 827.50+/-434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90+/-342.07 x Placebo group 439.42+/-349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18+/-0.92 x Placebo group 8.85+/-1.48 g/dL; P=0.11; hematocrit (%)-EACA group 28.15+/-3.35 x Placebo group 26.67+/-4.15%; P=0.06). CONCLUSION: Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery.
Assuntos
Ácido Aminocaproico/efeitos adversos , Antifibrinolíticos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Hemorragia Pós-Operatória/tratamento farmacológico , Administração Tópica , Ácido Aminocaproico/administração & dosagem , Antifibrinolíticos/administração & dosagem , Transfusão de Sangue/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJETIVO: Verificar o efeito do uso tópico do ácido epsilon-aminocapróico (AEAC), aplicado na cavidade pericárdica, na redução do sangramento e necessidade de transfusão sanguínea no pós-operatório de revascularização cirúrgica do miocárdio. MÉTODOS: Entre outubro de 2007 e outubro de 2008, 53 pacientes da mesma instituição foram alocados em um estudo prospectivo, randomizado e duplo-cego. Foram selecionados portadores de insuficiência coronariana crônica com indicação para revascularização cirúrgica do miocárdio. Os pacientes foram divididos em dois grupos: grupo AEAC e grupo Placebo, comparados de acordo com as características clínicas, demográficas e variáveis operatórias. Foram avaliados o volume de sangramento pelos drenos, a necessidade de transfusão e os níveis de hemoglobina e hematócrito de pós-operatório. RESULTADOS: O sangramento pós-operatório pelos drenos nas primeiras 24 horas (grupo AEAC 154,66±74,64 x grupo placebo 220,21±136,42 ml; P=0,031) foi menor no grupo AEAC, porém, em 48 horas (grupo AEAC 259,14±420,07 x grupo placebo 141,67±142,58 ml; P=0,197) e a perda acumulada até a retirada dos drenos (grupo AEAC 832,07±576,86 x grupo placebo 827,50±434,12 ml; P=0,975) não apresentou diferença estatística significante. Houve menor necessidade de transfusão no grupo AEAC, com diferença estatística significante (grupo AEAC 185,90±342,07 x grupo placebo 439,42±349,07 ml; P=0,016). Os valores de hemoglobina (grupo AEAC 9,18±0,92 x grupo placebo 8,85±1,48 g/dL; P=0,331) e hematócrito (grupo AEAC 28,15±3,35 x grupo placebo 26,67±4,15 por cento; P=0,162) não mostraram diferença estatística significante na comparação entre os grupos. CONCLUSÕES: O uso tópico do ácido epsilon-aminocapróico apresentou efeito favorável na redução do sangramento nas primeiras 24 horas de pós-operatório e na necessidade de transfusão sanguínea após revascularização cirúrgica do miocárdio. Trabalhos adicionais com maior número de pacientes serão necessários ...
OBJECTIVE: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. METHODS: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. RESULTS: Postoperative bleeding within first 24 hours (h) period (EACA group 154.66±74.64 x Placebo group 220.21±136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14±420.07 x Placebo group 141.67±142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07±576.86 x Placebo group 827.50±434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90±342.07 x Placebo group 439.42±349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18±0.92 x Placebo group 8.85±1.48 g/dL; P=0.11; hematocrit ( percent)-EACA group 28.15±3.35 x Placebo group 26.67±4.15 percent; P=0.06). CONCLUSION: Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery