Surgical myocardial revascularization without extracorporeal circulation / Revascularização cirúrgica do miocárdio sem circulação extracorpórea

OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5 percent) of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease

Pós-operatório em cirurgia cardíaca de adultos / Postoperative of cardiac surgery in adultos

Com o progresso da cirurgia cardíaca, observou-se acentuada reduçäo de sua morbidade e mortalidade, permitndo que essas operaçöes fossem realizadas em pacientes de maior risco. O melhor conhecimento das alteraçöes produzidas pela circulaçäo extracorpórea aliado ao alto grau de especializaçäo dos profissionais responsáveis pelos cuidados pós-operatórios tiveram grande influência sobre essa reduäo. Porém, visto que muitos dos pacientes operados säo idosos, diabéticos, hipertensos e tabagistas, a incidência de complicaçöes renais, pulmonares e neurológicas pode ser elevada. A açäo integrada de uma equipe multidisciplinar e multiprofissional é muito útil na prevençäo dessas complicaçöes. Analgesia adequada e medidas de humanizaçäo atualmente bastante valorizadas nas terapias intensivas têm tornado a convalescença pós-cirúrgica menos desconfortável.