medigraphic.com
ISSN 1561-2937 (Impreso)

2020, Número 3

<< Anterior Siguiente >>

Rev Cubana Cardiol Cir Cardiovasc 2020; 26 (3)


Revascularización miocárdica completa sin circulación extracorpórea con arterias mamarias internas

Rodríguez RV, Salvatierra TVH, Tarrago LY, Paredes CÁM, Pérez LH

Idioma: Español
Referencias bibliográficas: 33
Paginas: 1-12
Archivo PDF: 389.01 Kb.


RESUMEN

Introducción: La enfermedad arterial coronaria es la patología cardiaca más frecuente y cada vez un mayor número de enfermos requieren de un procedimiento quirúrgico para revascularizar el miocardio. Objetivos: Comprobar los beneficios de la cirugía de revascularización miocárdica completa sin circulación extracorpórea con arterias mamarias internas en cuanto a morbilidad y mortalidad hospitalaria. Método: Estudio analítico y prospectivo, en pacientes que requirieron de forma consecutiva una cirugía de revascularización miocárdica, desde mayo 2018 - septiembre 2019, en el Instituto de Cardiología y Cirugía Cardiovascular. Resultados: La hipertensión arterial, el hábito de fumar, la diabetes mellitus y la dislipidemia fueron los factores de riesgo más frecuentes. En el 93,8% de los pacientes estaban presentes tres o más factores de riesgo. La incidencia de mortalidad (2,5%) fue baja, con una supervivencia libre de eventos cardiacos y cerebrovasculares adversos mayores del 96%. La aparición de eventos cardiacos y cerebrovasculares adversos mayores se relacionó con la mortalidad a 30 días. Conclusiones: La cirugía de revascularización miocárdica completa sin circulación extracorpórea, exclusivamente con arterias mamarias internas, en pacientes con enfermedad arterial coronaria multivaso, se puede realizar con una baja incidencia de morbilidad y mortalidad a los 30 días. Se encontró relación entre la aparición de eventos cardiacos y cerebrovasculares adversos mayores y la mortalidad hospitalaria.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation [Internet]. 2017 Mar [cited 2019 Sep 15]; 135(10):[about 457 p.]. 146-603. Available from: https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000485

  2. Armas NB, Dueñas AF, de la Noval R, Ortega YY, Acosta M, Morales A. Cardiopatía Isquémica en Cuba. Una puesta al día. 2015. Rev Cuban Cardiol [Internet]. 2015 May [citado 15 Sep 2019];21(3):[aprox. 6 p.]. Disponible en: http://www.revcardiologia.sld.cu/index.php/revcardiologia/article/view/597/pdf_15.

  3. Neumann FJ, Sousa M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. Guía ESC/EACTS 2018 sobre revascularización miocárdica. Rev Esp Cardiol [Internet]. 2019 Ene [citado 15 Sep 2019];72(1):1-76. Disponible en: https://www.revespcardiol.org/es-guia-esc-eacts-2018-sobre-revascularizacion-articulo-S0300893218306377.

  4. Shaefi S, Mittel A, Loberman D, Ramakrishna H. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting-A Systematic Review and Analysis of Clinical Outcomes. J Cardiothorac Vasc Anesth [Internet]. 2019 Jan [cited 2019 Sep 15];33(1):232-44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29753665.

  5. Fudulu D, Benedetto U, Pecchinenda GG, Chivasso P, Bruno VD, Rapetto F, et al. Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials. J Thorac Dis [Internet]. 2016 Aug [cited 2019 Sep 15];8(10):[about 14 p.]. Available from: http://jtd.amegroups.com/article/view/10034/pdf.

  6. González JM. Revascularización arterial completa: ¿debe ser siempre nuestro objetivo?. Cir Cardiov [Internet]. 2006 Oct [citado 15 Sep 2019];13(4):279-86. Disponible en: https://www.sciencedirect.com/science/article/pii/S1134009606702947.

  7. Wendler O, Hennen B, Demertzis S, Markwirth T, Tscholl D, Lausberg H, et al. Complete Arterial Revascularization in Multivessel Coronary Artery Disease With 2 Conduits (Skeletonized Grafts and T Grafts). Circulation [Internet]. 2000 Nov [cited 2019 Sep 15];102(3):79-83. Available from: https://www.ahajournals.org/doi/10.1161/circ.102.suppl_3.III-79.

  8. Buxton BF, Hayward PA. The art of arterial revascularization—total arterial revascularization in patients with triple vessel coronary artery disease. Ann Cardiothorac Surg [Internet]. 2013 Jul [cited 2019 Sep 15];2(4):543-51. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741893/pdf/acs-02-04-543.pdf.

  9. Anyanwu AC, Adams DH. Total Arterial Revascularization for Coronary Artery Bypass. J Am Coll Cardiol [Internet]. 2018 Sep [cited 2019 Sep 15];72(12):1341-5. Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0735109718357334.pdf?locale=es_ES&searchIndex.

  10. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the internal mammary artery graft on 10 year survival and other cardiac events. N Engl J Med [Internet]. 1986 Jan [cited 2019 Sep 15];314(1):1-6. Available from: https://www.nejm.org/doi/full/10.1056/NEJM198601023140101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed.

  11. Taggart DP, Altman DG, Gray AM, Lees B, Gerry S, Benedetto U, et al. Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts. N Engl J Med [Internet]. 2016 Dec [cited 2019 Sep 15];375:2540-9. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1610021.

  12. Tabata M, Grab JD, Khalpey Z, Edwards FH, O'Brien SM, Cohn LH, et al. Prevalence and Variability of Internal Mammary Artery Graft Use in Contemporary Multivessel Coronary Artery Bypass Graft Surgery. Circulation [Internet]. 2009 Aug [cited 2019 Sep 15];120(11):935-40. Available from: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.832444.

  13. Tatoulis J. Injertos arteriales múltiples en cirugía coronaria: razonamiento e importancia. Cir Cardiov [Internet]. 2008 Jun [citado 15 Sep 2019];15(2):[aprox. 10 p.]. Disponible en: https://www.elsevier.es/es-revista-cirugia-cardiovascular-358-pdf-S1134009608702055.

  14. Sullivan PG, Wallach JD, Ioannidis JP. Meta-analysis comparing established risk prediction models (EuroSCORE II, STS Score, and ACEF Score) for perioperative mortality during cardiac surgery. Am J Cardiol [Internet]. 2016 Nov [cited 2019 Sep 15];118(10):1574-82. Available from: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0002914916313844?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0002914916313844%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F.

  15. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. The risk of assessing mortality risk in elective cardiac operations. Age, creatinine, ejection fraction and the law of parsimony. Circulation [Internet]. 2009 Jun [cited 2019 Sep 15];119(24):[about 8 p.]. Available from: https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.108.842393.

  16. Fukui T, Tabata M, Morita S, Takanashi S. Sequential free right internal thoracic artery grafting for multivessel coronary artery bypass grafting. J Thorac Cardiovasc Surg [Internet]. 2012 Oct [cited 2019 Sep 15];114(4):824-9. Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0022522311012955.pdf?locale=es_ES&searchIndex=.

  17. Dayan V, Marichal A, Paganini JJ, Pérez A, Straneo P, Brusich D. Revascularización arterial coronaria mediante el uso de ambas arterias mamarias internas en pacientes con ángor estable. Datos nacionales. Rev Urug Cardiol [Internet]. 2018 Mar [citado 15 Sep 2019];33(1):20-42. Disponible en: http://www.scielo.edu.uy/pdf/ruc/v33n1/1688-0420-ruc-33-01-20.pdf.

  18. Nakajima H, Kobayashi J, Toda K, Fujita T, Shimahara Y, Kasahara Y, et al. Angiographic evaluation of flow distribution in sequential and composite arterial grafts for three vessel disease. Eur J Cardiothorac Surg [Internet]. 2011 Dec [cited 2019 Sep 15];41(4):763-9. Available from: https://academic.oup.com/ejcts/article/41/4/763/643075.

  19. Buffolo E, Juffé A. Estudio SYNTAX, de la evidencia a la desobediencia. Cir Cardiov [Internet]. 2013 Jun [citado 15 Sep 2019];20(2):52-54. Disponible en: https://www.elsevier.es/es-revista-cirugia-cardiovascular-358-pdf-S1134009613700159.

  20. Lytle B, Blackstone E, Loop F, Houghtaling P, Arnold J, Akhrass R et al. Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg [Internet]. 1999 Jan [cited 2019 Sep 15];117(5):855-72. Available from: https://www.sciencedirect.com/science/article/pii/S002252239970365X?via%3Dihub.

  21. Urso S, Sadaba R, Tena MA, Bellot R, Ríos L, Martínez-Comendador JM, et al. Arteria mamaria interna esqueletizada versus pediculada: una revisión sistemática. Cir Cardiov [Internet]. 2019 Abr [citado 15 Sep 2019]; 26(3):162-68. Disponible en: https://www.elsevier.es/es-revista-cirugia-cardiovascular-358-pdf-S1134009619301147.

  22. Benedetto U, Altman DG, Gerry S, Gray A, Lees B, Pawlaczyk R, et al. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg [Internet]. 2016 Jul [cited 2019 Sep 15];152(1):270-6. Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0022522316300307.pdf?locale=es_ES&searchIndex=.

  23. Glineur D, Boodhwani M, Hanet C, Kerchove L, Navarra E, Astarci P, et al. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery A Prospective Randomized Trial. Circ Cardiovasc Interv [Internet]. 2016 May [cited 2019 Sep 15];9(7):[about 6 p.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949001/pdf/hcv-9-e003518.pdf.

  24. Tinica G, Chistol RO, Iliescu DB, Furnica C. Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique. Exper Therap Med [Internet]. 2018 Nov [cited 2019 Sep 15];17(1):359-67. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307371/pdf/etm-17-01-0359.pdf.

  25. Glineur D. La elección del segundo injerto. Rev Esp Cardiol [Internet]. 2013 Mar [citado 15 Sep 2019];66(6):27-31. Disponible en: https://www.revespcardiol.org/es-pdf-S0300893213000547.

  26. Carvalho AR, Guizilini S, Murai GM, Begot I, Rocco IS, Hossne NA, et al. Hemodynamic Changes During Heart Displacement in Aorta No-Touch Off-Pump Coronary Artery Bypass Surgery: A Pilot Study. Braz J Cardiovasc Surg [Internet]. 2018 Aug [cited 2019 Sep 15];33(5):469-75. Available from: http://www.scielo.br/pdf/rbccv/v33n5/0102-7638-rbccv-33-05-0469.pdf.

  27. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. N Engl J Med [Internet]. 2009 Nov [cited 2019 Sep 15];361(19):1827-37. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa0902905.

  28. Houlind K, Fenger-Gron M, Holme SJ, Kjeldsen BJ, Madsen SN, Rasmussen BS, et al. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). J Thorac Cardiovasc Surg [Internet]. 2014 Nov [cited 2019 Sep 15];148(5):1812-9. Available from: https://www.scopus.com/record/display.uri?eid=2-s2.0-84910144946&origin=inward.

  29. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, et al. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med [Internet]. 2016 Dec [cited 2019 Sep 15];375(24):2359-68. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1601564.

  30. Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A, et al. Off-Pump versus On-Pump Coronary-Artery Bypass Grafting in Elderly Patients. N Engl J Med [Internet]. 2013 Mar [cited 2019 Sep 15];368(13):1189-98. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1211666.

  31. Tenaa MA, Ursoa S, Martínez JM, Bellot R, Gutiérrez EM, González JM, et al. Cirugía coronaria sin bomba: revisión sistemática contemporánea y metaanálisis de sus resultados respecto a la cirugía con circulación extracorpórea. Cir Cardiov [Internet]. 2019 Feb [citado 15 Sep 2019];26(2):81-91. Disponible en: https://www.elsevier.es/es-revista-cirugia-cardiovascular-358-pdf-S1134009619300798.

  32. Sellke FW, Di Maio JM, Caplan LR, Ferguson TB, Gardner TJ, Hiratzka LF, et al. Comparing On-Pump and Off-Pump Coronary Artery Bypass Grafting: Numerous Studies but Few Conclusions. A Scientific Statement From the American Heart Association Council on Cardiovascular Surgery and Anesthesia in Collaboration With the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation [Internet]. 2005 Jun [cited 2019 Sep 15];111(21):2858-64. Available from: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.105.165030.

  33. Navia DO, Vrancic M, Piccinini F, Camporrotondo M, Dorsa A, Espinoza J, et al. Myocardial Revascularization Exclusively With Bilateral Internal Thoracic Arteries in T-Graft Configuration: Effects on Late Survival. Ann Thorac Surg [Internet]. 2016 Jan [cited 2019 Sep 15];101(5):1775-81. Available from: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0-S0003497515017464.pdf?locale=es_ES&searchIndex=.




2020     |     www.medigraphic.com