Cirurgia de revascularização do miocárdio minimamente invasiva com utilização da videotoracoscopia / Minimally Invasive Myocardial Bypass Surgery Using Video-Assisted Thoracoscopy

PURPOSE: In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. METHODS: Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered. RESULTS: All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke. CONCLUSION: MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.

Resultados da substituiçäo da aorta ascendente e valva aórtica com reimplante de artérias coronárias / Results of replacement of ascending aorta and aortic valve with reimplantation of coronary arteries

Avaliar a técnica de substituiçäo da valva aórtica e aorta ascendente com reimplante de artérias coronárias no tratamento cirúrgico de aneurismas da aorta ascendente. Entre janeiro de 1980 e dezembro de 1989, 38 paciente sforam operados por essa técnica. Vinte e dois pacientes eram portadores de aneurisma da aorta ascendente com insuficiência da valva aórtica; 14 de dissecçäo crônica de aorta e dois foram operados por dissecçäo na fase aguda. Quatro doentes haviam sido operados previamente por outras técnicas. A mortalidade imediata foi de 5,2%; um paciente por baixo débito e outro por complicaçäo neurológica. Cinco doentes (13,1%) morreram tardiamente, dos quais dois subitamente. O seguimento dos 31 sobreviventes variou de 2 a 72 meses com média de 25; (29(93,5%) estavam na classe funcional I e dois em classe II. Dezesseis pacientes foram submetidos a reestudo por um ou mais dos seguintes métodos: angiografia digital, tomografia computadorizada, ecocardiograma ou angiografia convencional, de 6 a 60 meses após a operaçäo, com média de 33 meses. Todos apresentavam boas condiçöes dos óstios coronários e das próteses. Os resultados imediatos e tardios foram semelhantes nos pacientes operados por dissecçäo ou aneurisma verdadeiro. A técnica de substituiçäo de valva aórtica e aorta ascendente com reimplante de artérias coronárias apresenta baixa mortalidade e bons resultados tardios

Purpose - To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. Patients and Methods - From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. Results The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital ang iography, ches t computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. Conclusion - The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome