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2011, Number 1

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Revista Cubana de Cirugía 2011; 50 (1)

Comparison of results of myocardial revascularization with beating heart, with and without extracorporeal circulation

Echemendía SED, Villar IA, Nafeh AM, Pedroso RJ, Martí PD, Hidalgo CT

Language: Spanish
References: 20
Page: 25-39
PDF size: 236.35 Kb.


ABSTRACT

INTRODUCTION. The surgical myocardial revascularization with beating heart and without extracorporeal circulation (ECC) is a potential strategy to decrease the mortality and the morbidity in patients presenting with ischemic heart disease. The objective of present research was to describe the results of surgical myocardial revascularization with beating heart, with or without ECC.
METHODS. A prospective, longitudinal and descriptive study was conducted of cases series type where the sample included 159 patients underwent beating heart myocardial revascularization (143 without ECC and 16 with EEC) en the "Hermanos Ameijeiras" Clinical Surgical Hospital in 2007.
RESULTS. The mean age of the 159 patients operated on was of 63,9 years. There was predominance of male sex (74,2%), white race (81,1%), chronic and stable exertion angina (86,8%), dyslipidemia (84,3%), high blood pressure (81,2%), use of two or more anti-ischemia drugs (83,0%), III functional class (64,2%), sinus cardiac rhythm (98,1%), trunk lesion associated to multi-vessel disease (54,1%) and sternotomy approach (93,1%). There were statistically significant differences in favor of the patients without ECC as regards the complete revascularization (p = 0,006), inotropic drugs (p = 0,000), haemoderivatives (p = 0,022), surgical time (p = 0,000) and anesthetics (p = 0,000), use of contrapulsation balloon (p = 0,001), medium extubation (p = 0,003) and intensive care unit stay (p = 0,011). The overall mortality was of 5,0%, more significant when ECC was used (p = 0,001) and similar when both techniques were compared in relation to respiratory sepsis, renal dysfunction, pleural effusion, low cardiac output, postoperative hemorrhage and decompensation of diabetes mellitus.
CONCLUSIONS. We conclude that the use of extracorporeal circulation as help in beating heart myocardial revascularization yielded unsatisfactory results.


REFERENCES

  1. MINSAP. Anuario Estadístico 2007. Principales causas de muerte de todas las edades 2007. [fecha de acceso 20 de julio de 2008]. Disponible en: http://bvs.sld.cu/anuario/tablas/ANUARIOCU1.1-1749.htm

  2. Schumaaker HB Jr. The evolution of cardiac surgery. Indiana: Indiana University Press; 1992. p. 13.

  3. Kolesov VI, Patashov LV. Operations on the coronary arteries. Exp Chir Anaesth 1965;54:535.

  4. Kolesov VI, Potashov LV. Surgery of coronary arteries. Eksp Khir Anesteziol. 1965;10:3-8.

  5. Kolesov VI, Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris. J Thoracic Cardiovas Surg. 1967;54:535-44.

  6. Garrett HE, Dietrich EB, DeBakey ME. Myocardial revascularization. Surg Clin N Am. 1966;46:863-71.

  7. Favoloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease: Operative technique. J Thorac Cardiovasc Surg. 1969;58:178-85.

  8. Sergeant P. The future of coronary bypass surgery. Eur J Cardiothorac Surg. 2004;26Suppl:S4-7.

  9. Buffolo E, Silva de Andrade JC, Rdgues. Branco JN, et al. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg. 1996;61:63-6.

  10. Ardá Bravo M, Cuenca JJ, Juffé A. Cirugía de revascularización coronaria. ¿Se puede prescindir de la circulación extracorpórea? Enferm Cardiol 2002;IX(27):24-9.

  11. Hernández R, Rodríguez J. Estrategias de revascularización: importancia del sexo. Rev Esp Cardiol 2006;59:487501.

  12. Herreros J. Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales. Rev Esp Cardiol 2005;58:110716.

  13. Pérez H, Blázquez JT. Revascularización miocárdica sin el uso de circulación extracorpórea o parada cardíaca (Trabajo para optar por el grado de Doctor en Ciencias Médicas). La Habana: Instituto de Cardiología y Cirugía Cardiovascular; 2002.

  14. Gómez MV. Parámetros de calidad en la atención al paciente sometido a cirugía de revascularización. [monografía en línea]. Disponible en: http://www.monografias.com/trabajos18/atencion-cirugia-coronaria/atencion-cirugia-coronaria.shtml

  15. Herrera V. Cirugía de revascularización coronaria sin pinzamiento aórtico, ventajas y resultados. Arch CardiolMéx. 2006;76(S 2):112-6.

  16. Davit S. Is 100% beating heart coronary by-pass justified? Cardiovascular Surg. 2002;6:57985.

  17. Martínez Canalejo H. Revascularización coronaria sin la utilización de derivación cardiopulmonar en el Centro Médico Nacional "La Raza" (México). Experiencia inicial. Rev Mex Cardiol 2000;11(4):297-300.

  18. Iscan HZ. Coronary reoperations without the use of cardiopulmonary bypass. Cardiovascular Surgery. 2003;11(2):155-8.

  19. Vaccarino ZhQL, Kasl SV, Mattera JA. Sex Differences in health status after coronary artery bypass surgery. Circulation. 2003;108;2642-7.

  20. Babatasi. Pre-Operative balloon contrapulsation and off pump coronary surgery for high-risk patients. Cardiovascular Surg. 2003;11(2):145-8.




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