Objective: To evaluate the immediate postoperative results of off-pump myocardium revascularization surgery by analyzing complications and mortality. Method: A total of 1440 patients were submitted to offpump myocardium revascularization. The surgical technique consisted in proximal occlusion of the approached artery, the application of the LIMA graft in the posterior pericardial deflection and stabilization of the target artery with a suction stabilizer. The distal anastomoses were performed first. Results: Among the patients evaluated, 924 were male and 516 were female, with a mean age of 63.12 ± 8.76 years. The ejection fraction was normal in 749 patients, 740 (51.4%) patients had suffered previous myocardial infarction and 687 (47.6%) patients were in functional class III or IV. The mean EuroSCORE was 4.93 ± 3.32. The mean number of distal anastomoses was 3.12 ± 1.23 per patient. A total of 1173 (81.5%) patients remained less than 12 hours on mechanical ventilation and among these, 888 (61.7%) remained for less than six hours. The stay in the ICU was of one night for 330 (22.8%) patients, for two nights for 930 (64.6%) patients and 182 (12.4%) patients remained for three or more nights. In regards to complications, three (0.2%) patients presented with renal insufficiency, six (0.4%) patients suffered strokes, nineteen (1.3%) patients were reoperated for bleeding, nineteen (1.3%) patients had mediastinitis, eighteen (1.25%) patients suffered severe myocardial infarction and 212 (14.7%) presented atrial fibrillation. There were 50 (3.5%) deaths, 29 (2.5%) of them being among the 1148 patients operated electively, 9 (4.7%) among 190 patients submitted to coronary re-operation and 12 (11.7%) among 102 patients undergoing emergency operations. Conclusion: With the evolution of biomedical technological, all the vessels of the heart are now approached. These data suggest that the operation for myocardial revascularization is safe and efficient. It can be applied to all patients who need coronary surgery, with low rates of complication and mortality.

SummaryObjective: To assess off-pump myocardial revascularization in patients with significant left ventricular dysfunction.Methods: Four hundred and five patients with an ejection fraction less than 35% underwent myocardial revascularization without extracorporeal circulation. The procedure was performed with the aid of a suction stabilizer and the LIMA stitch. The distal anastomoses were performed first.Results: A total of 405 patients were evaluated whose mean age was 63.4±9.78 years. Two hundred and seventy-nine patients were men (68.8%). With regard to risk factors, 347 patients were hypertensive, 194 were smokers, 202 were dyslipidemic, and 134 had diabetes. Two hundred and sixty patients were classified as NYHA functional class III and IV. Twenty patients suffered from chronic renal disease and were under dialysis. Fifty-one underwent emergency surgery, and 33 had been previously operated on. The mean ejection fraction was 27.2±3.54%. The mean EuroSCORE was 8.46±4.41. The mean number of anastomoses performed was 3.03±1.54 per patient. Forty-nine patients (12%) needed an intra-aortic balloon inserted after induction of anesthesia, whereas 73 (18%) needed inotropic support during the perioperative period. As to complications, 2 patients (0.49%) had renal failure, 2 had mediastinitis (0.49%), 7 (1.7%) needed to be reoperated because of bleeding, 5 patients (1.2%) suffered acute myocardial infarction, and 70 patients (17.3%) experienced atrial fibrillation. Eighteen (4.4%) patients died. Conclusion

SummaryBackground: Atrial fibrillation is the most common complication after myocardial revascularization, and it increases morbidity/mortality.