Dupla artéria torácica esqueletizada versus convencional na revascularização do miocárdio sem CEC em diabéticos

Abstract

Dupla artéria torácica esqueletizada versus convencional na revascularização do miocárdio sem CEC em diabéticosDouble skeletonized internal thoracic artery vs. double conventional internal thoracic artery in diabetic patients submitted to OPCAB Abstract Objective: To evaluate the influence of the technique used in the dissection of thoracic arteries in the evolution of diabetic patients submitted to OPCAB.Methods: Seventy diabetic patients submitted to OPCAB using bilateral thoracic arteries were evaluated. In Group A, thoracic arteries were dissected as a pedicle, while in Group B they were skeletonized.Results: The mean age of patients in Group A was 52.14 ± 7.35 years old versus 55.71 ± 8.1 years for Group B (p=0.057). In Group A, six patients (17.1%) were insulin dependent against nine (25.7%) in Group B (p = 0.561). The EUROSCORE was 3.97 ± 2.49 for Group A opposed to 4.14 ± 3.06 for Group B (p = 0.879). The number of distal anastomoses in Group A was 3 ± 0.77 versus 3.03 ± 0.89 in Group B (p = 0.981). Three patients (8.57%) from Group A presented with mediastinitis. Insulin dependence was the only significant risk factor (p=0.008) for mediastinitis. In this group the use of skeletonized ITAs significantly decreased the incidence of mediastinitis (p = 0.044).Conclusion: The incidence of mediastinitis was lower in the group for which thoracic arteries were dissected using skeletonization. Among insulin-dependent diabetics, 50% of the patients from the group in which the pedicled internal thoracic artery was utilized presented with mediastinitis; the utilization of skeletonized ITAs significantly decreases the incidence of mediastinitis. Rev Bras Cir Cardiovasc 2008; 23(3): 351-357 Descriptors

Diabéticos devem ter a artéria torácica interna esqueletizada? Avaliação da perfusão esternal por cintilografia

“…Rev Bras Cir Cardiovasc 2009; 24 (2): [157][158][159][160][161][162][163][164] the sternum [15,16], as observed recently in our country [17].…”

Myocardial revascularization without cardiopulmonary bypass

“…During the next decade, there were mainly observational studies and few randomized clinical trials comparing on and off pump coronary artery surgery in terms of morbidity, mortality, inflammatory response, patency rates, stroke, blood transfusion, costs, hospital mortality in high risk patients, and others [30][31][32][33][34][35][36][37][38][39][40][41]. Controversial results from these studies led to different opinions regarding the routine application of off pump coronary surgery [42][43][44][45][46][47][48].…”

Apologia ao uso da dupla mamária

“…Recent studies found that diabetic patients may present high sternum infectious complication rates if they make use of the dissected ITA pedicle [8,9]. However, Santos Filho et al [10] showed that in this group of patients, sternal perfusion is lower than in non-diabetics, justifying a higher rate of infectious complications.…”

“…However, Santos Filho et al [10] showed that in this group of patients, sternal perfusion is lower than in non-diabetics, justifying a higher rate of infectious complications. Alternatively, when the ITA is dissected in a skeletonized fashion, sternal perfusion, with the use of scintigraphy, does not suffer a significant reduction, which seems to be the reason to reduce rates of infectious complications of the sternum and mediastinal disorders in diabetic patients in which two ATI were used [8,9].…”