Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriais

Abstract

Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriaisLong-term follow-up of patients undergone coronary artery bypass grafting with exclusive use of arterial grafts Abstract Objective: To evaluate the long-term results of coronary artery bypass grafting with the exclusive use of arterial grafts for patients with triple vessel disease.Methods: We evaluated 136 patients who underwent isolated coronary artery bypass grafting between January 1995 and December 1997. A total of 353 grafts were used for revascularization of 449 arteries (mean: 3.30 per patient). Grafts used were the left internal thoracic artery (99.2%), right internal thoracic artery (56.6%), radial artery (87.5%), right gastroepiploic artery (20.5%) and one inferior epigastric artery. Seventy-six (55.8%) patients received composite grafts ("Y-shape") and 66 (48.5%) patients received sequential anastomoses.Results: Hospital mortality was 4.4%. In the long-term follow-up (9.5 to 12.8 years), 82.1% of the patients were free of cardiac events. Twenty (17.9%) patients had hospital readmission due to cardiac events: 15 presented angina and five presented acute myocardial infarction, with three of them presenting with associated heart failure. Eight (7.1%) patients needed coronary re-interventions: one underwent coronary bypass reoperation and the others underwent coronary angioplasty with stent implantation. Estimated probability of being event-free was 98.2%, 95.4% and 84.2% at 1, 5 and 10 years of follow-up respectively. There were 16 (14.2%) late deaths with four of them (3.6%) being cardiacrelated. Actuarial 12.8-year survival of all types of death was 85% in this group.Conclusion: Coronary artery bypass grafting with the exclusive use of arterial grafts is a safe procedure for patients with triple vessel coronary disease with good long-term results.Descriptors: Myocardial revascularization. Arteriosclerosis/ surgery. Mammary arteries. Radial artery. ResumoObjetivo: Avaliar os resultados a longo prazo da cirurgia de revascularização do miocárdio com o uso exclusivo de enxertos arteriais em pacientes com doença coronariana triarterial.

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy

“…Consistent with previously reported actuarial 5‐year survival rates between 64% and 73%,16,17,19,20,22 the long‐term outcomes after myocardial revascularization were also satisfactory in the present study. Progress in perioperative management of patients with end‐stage ischemic heart disease6 has been instrumental in transitioning bypass grafting from a high‐risk neglected alternative to transplantation6,7 to a low‐risk routine modality.…”

“…The rationale for not employing the left thoracic artery in the past in patients with ICM was due to apprehension about complications related to advanced age, urgency of revascularization, and reserved anxiety about long‐term prognosis 16. However, the findings of this study and other recent studies16,17,19-23 suggest that there is little cause for concern. Thus, patients with ICM should be managed with a left internal thoracic artery graft when revascularization is selected therapy 15.…”

“…In particular, patient selection principles are not consistent among the various clinical reports with regard to the values of left ventricular ejection fraction and the inclusion of patients with acute myocardial infarction, left ventricular aneurysm, or valve disease who require surgical management 5. Despite these limitations, a surgical mortality rate varying from 2% to 10% has been reported for a considerable number of consecutive patients 6,7,14,16,17,19,20,22. …”

Impacto das publicações científicas brasileiras nos recentes avanços científicos na cardiologia

“…Other important studies were those on the best preservation of venous grafts 34,35 , the use of arterial grafts 36,37 and the comparison between the on-or off-pump CABG surgery 38 .…”

Predição do sucesso da cirurgia de revascularização miocárdica em pacientes com coronariopatia difusa: a contribuição do heart team

“…Dessa forma, em serviços experientes que apresentem bons resultados cirúrgicos e baixa taxa de complicação, como o nosso 40,41 , dar-se-ia preferência à utilização de enxertos arteriais, especialmente de ATI, para territórios mais nobres, como o do RIVA, enquanto os venosos ou outros enxertos arteriais são utilizados para os demais territórios 6,31 .…”