<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

Abstract

Objective: to analyze intra-hospital results in patients undergoing elective off-pump total arterial revascularization and identify morbidity and mortality predictors using this surgical strategy.Methods: From May 1999 to February 2004, 203 myocardial revascularization procedures with total arterial revascularization without cardiopulmonary bypass (off-pump) were carried out in patients with multivessel disease (three vessels 81.7 %, one vessel disease was excluded). We report pre-surgical variables and co-morbidities: average age 63.9 ± ± ± ± ± 9.13 years, men 182 (89.5%), hypertension 132 (65%), smokers 125 (61%), hypercholesterolemia 152 (74.8%), previous myocardial infarction (> 30 days) 73 (35%), moderate to severe ventricular dysfunction 31 (15%), redo 5 (2.5%). Total arterial revascularization included T-grafts and sequential grafts with left internal mammary (100%), right internal mammary (56.6%) and radial (63%) arteries. The total number of distal anastomosis was 576 (mean of 3 grafts/patient), all carried out with external mechanical stabilizers. There were no proximal aortic anastomoses. Conversion to on-pump surgery occurred in 3 patients (1.5%). 90% of the patients was extubated in the operating room. The multiple logistic regression test was used for statistical analysis.Results: The postoperative incidence of atrial fibrillation was 12.8% (26), oligoanuric renal failure 3% (6), dialysis 0.49% (1), postoperative myocardial infarction 1.47% (3), low cardiac output 4% (8), Redo for bleeding 1.47% (3), mediastinitis 1.47% (3), stroke 1.47% (3). Intra-hospital mortality was 2.45% (5). The only independent 30 day morbidity predictor was age (p=0.033; OR 1.04; IC 95%: 1-1.08).Conclusion: Off-pump myocardial revascularization with arterial conduits for multiple vessel disease is feasible with a low 30-day morbidity and mortality.Descriptors: Coronary surgery. Off-pump circulation. Multiple vessel disease. Arterial conduits Cirurgia coronária com condutos arteriais múltiplos sem circulação extracorpóreaOff-pump coronary artery bypass with multiple arterial conduits 40 NAVIA, D ET AL -Off-pump coronary artery bypass with multiple arterial conduits Braz J Cardiovasc Surg 2005; 20(1): 39-45 INTRODUCTIONThe use of cardiopulmonary bypass (CPB) by heart surgeons over the last 35 years has enabled coronary artery bypass grafting in more complex patients with higher surgical risk giving better results. Nevertheless, its use is associated to a certain degree of morbidity and in some clinical situations to a higher incidence of post-surgical morbidity and mortality. The undesirable effects of cardiopulmonary bypass are expressed as physiological disorders secondary to the exposure of blood to plastic tubes, oxygenators and filters, which, combined with the use of surgical field aspirators, destroy red and white blood cells and platelets. Likewise, it has been shown that this activates the inflammatory system with the release of cytokines and the increase of capillary patency and the potential threat to ...

Advances in Coronary Heart Disease Surgery in Latin America

“…9 On the contrary, most series with a lower average age have a predominance of male sex. 10 This observation could correlate with the global trend in Latin America to treat women less aggressively than men. 11 Parallel to the above-mentioned increase in age ranges is the cumulative increase in the number and severity of comorbidities of patients undergoing surgery.…”

“…Although off-pump surgery is the rule in certain institutions, other institutions apply selection criteria related to the patient's risk when this kind of procedure is chosen. 10,27 With regard to remodeling techniques for the failing and dilated left ventricle, special care must be taken if remodeling of akinetic muscle or even diskinetic regions is considered. Remodeling is performed in some Brazilian teams in almost 9% of cases (personal communication from E. Buffolo, November, 2005), whereas in Argentina the rates of remodeling technique use are estimated at 2.23%.…”