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1.
Arch. cardiol. Méx ; 90(4): 467-474, Oct.-Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152821

ABSTRACT

Resumen Objetivo: Comparar las tasas de recurrencia de revascularización coronaria (cirugía o intervención coronaria percutánea), nuevo evento isquémico o muerte en pacientes con puentes secuenciales y con puentes simples. Método: Cohortes ambispectivas de pacientes sometidos a cirugía de revascularización coronaria secuencial (n = 111) o simple (n = 145) entre el 1 de enero de 2013 y el 31 de diciembre de 2017. Pacientes mayores de 18 años en un primer procedimiento de revascularización, con circulación extracorpórea. Para el seguimiento se realizó revisión del expediente o comunicación telefónica hasta el 9 de febrero de 2019. Se investigaron los siguientes desenlaces: reintervención por isquemia coronaria, nuevo evento isquémico documentado o muerte atribuida a cardiopatía isquémica; también se obtuvieron curvas de sobrevida. Resultados: La proporción de recurrencia según la técnica quirúrgica no fue estadísticamente diferente: secuencial 6.5% (intervalo de confianza del 95% [IC95%]: 2.6-12.6%) contra simple 4.8% (IC95%: 2-9.7%; p = 0.60; análisis bayesiano BF10 = 0.37; evidencia moderada a no diferencia), todos por nuevo evento isquémico y un fallecimiento por grupo. No hubo diferencias en el tiempo de seguimiento: secuencial 59 meses (IC95%: 56-62) y simple 66 meses (IC95%: 64-68). No encontramos diferencia en las tasas de incidencia de recurrencia: secuencial 1.99 eventos/103 meses-paciente contra simple 1.47 (hazard ratio: 1.34; IC95%: 0.47-3.8; p = 0.58). El tiempo promedio de pinzamiento y de circulación extracorpórea por puente fue menor en el grupo de puentes combinados (41.44 minutos de circulación extracorpórea y 24.69 minutos de pinzamiento/puente) que en el de puentes simples (43 minutos en circulación extracorpórea y 26.4 minutos de pinzamiento/puente) cuando se ajusta al promedio de puentes colocados (simples 2.7 y secuencial 3.25; p < 0.001); sin embargo, no se encontró significancia estadística (p = 0.7). Conclusión: Ambos procedimientos tuvieron una baja incidencia de recurrencia de eventos clínicos, sin diferencias entre las técnicas quirúrgicas.


Abstract Objective: To compare the recurrence rates of revascularization (redo CABG or PCI), new ischemic event or death in patients with simple grafts and patients with sequential grafts. Method: Study design is an ambispective cohort of patients that underwent CABG by sequential grafting (n = 111) or simple grafting (n = 145) between January 1st, 2013 and December 31st, 2017. Patients had to be 18 years old at the time of surgery, undergoing their first on-pump CABG. The clinical record of every patient was carefully reviewed and patients who had incomplete follow-up in external consultation were contacted by telephone in order to obtain data about ischemia related reintervention (CABG or PCI), new documented ischemic event or death caused by coronary artery disease, Kaplan-Meier estimators were calculated. Results: The proportion of recurrence depending on technique was not statistically different: sequential (6.5% [CI95% 2.6-12.6%] versus simple 4.8% [CI95% 2-9.7%], p = 0.60, Bayesian analysis BF10 = 0.37; moderate evidence to no difference), each one related to new ischemic event and one death per group. There were no differences in follow-up time (sequential 59m [CI95% 56-62] simple 66m [CI95% 64-68]). No difference was found regarding recurrence incidence rates; sequential 1.99 events x 103 months-patient, versus simple 1.47 (HR=1.34; CI95% 0.47-3.8, p = 0.58). Pump and cross-clamping times were lower for sequential technique (41.44 min; 24.69 min respectively) versus simple technique (43 min; 26.4 min respectively) with a p = 0.7 after adjusting to mean grafts per surgery (2.7 simple; 3.25 sequential, p < 0.001). Conclusions: Both techniques had a low incidence of clinical recurrence, without significant differences between procedures.


Subject(s)
Humans , Middle Aged , Coronary Artery Bypass/methods , Myocardial Ischemia/surgery , Percutaneous Coronary Intervention/methods , Myocardial Revascularization/methods , Recurrence , Cohort Studies , Follow-Up Studies , Bayes Theorem
2.
Rev. bras. cir. cardiovasc ; 34(6): 667-673, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057505

ABSTRACT

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Radial Artery/surgery , Tissue and Organ Harvesting/methods , Dissection/methods , Electrocoagulation/methods , Ultrasonic Surgical Procedures/methods , Postoperative Period , Coronary Artery Bypass/methods , Radial Artery/pathology , Intercellular Adhesion Molecule-1 , Postoperative Hemorrhage
3.
Rev. bras. cir. cardiovasc ; 34(5): 517-524, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1042055

ABSTRACT

Abstract Objective: To evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG). Methods: This is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals. Results: High doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups. Conclusion: Vitamin C has significantly improved the patients' ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group. IRCT code: IRCT2016053019470N33


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Ascorbic Acid/administration & dosage , Myocardial Reperfusion Injury/prevention & control , Coronary Artery Bypass/methods , Antioxidants/administration & dosage , Arrhythmias, Cardiac/prevention & control , Time Factors , Biomarkers/blood , Myocardial Reperfusion Injury/blood , Double-Blind Method , Reproducibility of Results , Ventricular Function/drug effects , Treatment Outcome , Statistics, Nonparametric , Troponin I/blood , Creatine Kinase, BB Form/blood , Creatine Kinase, MM Form/blood , Hemodynamics/drug effects , Intensive Care Units , L-Lactate Dehydrogenase/blood
4.
Rev. bras. cir. cardiovasc ; 34(5): 581-587, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042051

ABSTRACT

Abstract Objective: The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). Methods: This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. Results: Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). Conclusion: Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/methods , Carotid Stenosis/diagnostic imaging , Ultrasonography, Doppler, Duplex/methods , Postoperative Complications/etiology , Time Factors , Severity of Illness Index , Logistic Models , Coronary Artery Bypass/adverse effects , Retrospective Studies , Risk Factors , Treatment Outcome , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Carotid Stenosis/etiology , Stroke/etiology , Preoperative Period
5.
Rev. bras. cir. cardiovasc ; 34(5): 588-595, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042049

ABSTRACT

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Polyglactin 910/therapeutic use , Saphenous Vein/surgery , Surgical Wound Infection/prevention & control , Triclosan/therapeutic use , Coronary Artery Bypass/methods , Suture Techniques , Anti-Infective Agents, Local/therapeutic use , Pain, Postoperative/prevention & control , Time Factors , Body Mass Index , Coronary Artery Bypass/adverse effects , Double-Blind Method , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Diabetes Complications
6.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4): 356-361, out.-dez. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1047212

ABSTRACT

O desenvolvimento das salas cirúrgicas híbridas permitiu que operações de abordagem cirúrgica convencional pudessem ser realizadas e complementadas com a abordagem percutânea e endovascular, criando uma nova forma de tratar os pacientes por meio de cirurgias híbridas. Os procedimentos híbridos permitem que cirurgiões e cardiologistas intervencionistas possam associar suas expertises para tratar, da melhor forma possível, os pacientes com doenças cada vez mais complexas e avançadas, com melhores resultados, reduzindo a morbidade e mortalidade perioperatória e permitindo recuperação mais rápida


The development of hybrid operating rooms allowed that conventional surgical approach operations could be performed and complemented with the percutaneous and endovascular approach, creating a new way of treating patients through hybrid surgeries. Hybrid procedures allow surgeons and interventional cardiologists to combine their expertise to best treat patients with increasingly complex and advanced diseases, with better outcomes, reducing perioperative morbidity and mortality and allowing faster recovery


Subject(s)
Cardiac Surgical Procedures/methods , Myocardial Revascularization/methods , Operating Rooms , Aorta, Thoracic , Prostheses and Implants , Aortography/methods , Coronary Artery Bypass/methods , Drug-Eluting Stents , Percutaneous Coronary Intervention/methods
7.
Rev. bras. cir. cardiovasc ; 34(4): 420-427, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020496

ABSTRACT

Abstract Objective: To evaluate the patency of individual and sequential coronary artery bypass in patients with ischemic heart disease. Methods: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data. Results: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%). Conclusion: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vascular Patency/physiology , Coronary Artery Bypass/methods , Myocardial Ischemia/surgery , Coronary Occlusion/therapy , Anastomosis, Surgical/methods , Radiographic Image Interpretation, Computer-Assisted , Risk Factors , Treatment Outcome , Coronary Angiography , Myocardial Ischemia/diagnostic imaging , Coronary Vessels/diagnostic imaging , Coronary Occlusion/diagnostic imaging , Computed Tomography Angiography
8.
Rev. bras. cir. cardiovasc ; 34(4): 480-483, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020495

ABSTRACT

Abstract The saphenous vein (SV) is the most commonly used conduit for coronary artery bypass surgery (CABG) and the second conduit of choice in Brazil and many other countries. The radial artery (RA) is suggested, by some, to be superior to SV grafts, although its use in the USA declined over a 10 year period. The patency of SV grafts (SVG) is improved when the vein is harvested with minimal trauma using the no-touch (NT) technique. This improved performance is due to the preservation of the outer pedicle surrounding the SV and reduction in vascular damage that occurs when using conventional techniques (CT) of harvesting. While the patency of NT SVGs has been shown superior to the RA at 36 months in one study, data from the RADIAL trial suggests the RA to be the superior conduit. When additional data using NT SVG is included in this trial the difference in risk of graft occlusion between the RA and SV grafts dissipates with there no longer being a significant difference in patency between conduits. The importance of preserving SV structure and the impact of NT harvesting on conduit choice for CABG patients are discussed in this short review.


Subject(s)
Humans , Saphenous Vein/transplantation , Coronary Artery Disease/surgery , Coronary Artery Bypass/methods , Radial Artery/transplantation , Vascular Patency , Brazil , Meta-Analysis as Topic , Treatment Failure
9.
Rev. bras. cir. cardiovasc ; 34(3): 297-304, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013476

ABSTRACT

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Saphenous Vein/transplantation , Blood Platelets/physiology , Vascular Patency/physiology , Coronary Artery Bypass/adverse effects , Platelet Count , Reference Values , Saphenous Vein/physiopathology , Coronary Artery Disease/etiology , Echocardiography , Logistic Models , Coronary Artery Bypass/methods , Predictive Value of Tests , Retrospective Studies , Risk Factors , ROC Curve , Age Factors , Coronary Angiography/methods , Treatment Failure , Statistics, Nonparametric , Hematologic Tests
10.
Rev. bras. cir. cardiovasc ; 34(3): 290-296, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013469

ABSTRACT

Abstract Objective: In this study, we aimed to examine the effects of amitriptyline, fluoxetine, tranylcypromine and venlafaxine on saphenous vein grafts in coronary artery bypass graft surgeries. Methods: 59 patients (40 males and 19 females; mean age 65.1 years, distribution: 45-84 years) who had coronary artery bypass graft surgery between February 2014 and May 2016 were included in the study. After the saphenous vein grafts with intact and denuded endothelium were precontracted with 3×10-6M phenylephrine, amitriptyline, fluoxetine and tranylcypromine were cumulatively added to isolated organ baths in the range of 10-11-3x10-5M, while venlafaxine was added in the range of 10-9-3×10-5M. Then, the antidepressant-induced relaxation responses were recorded isometrically. Results: While the relaxation response of amitriptyline at -6.42 (Log M) was 74.6%, the response at -6.32 (Log M) was 75.5%. While the relaxation response at -6.46 (Log M) of fluoxetine was 68.02%, the response at -6.02 (Log M) was 72.12%. While the relaxation response of tranylcypromine at -7.53 (Log M) was 61.13%, the response at -7.23 (Log M) was 65.53%. While the relaxation response of venlafaxine at -6.21 (Log M) was 29.98%, the response at -5.90 (Log M) was 32.96%. Conclusion: The maximum relaxation at minimum and maximum therapeutic concentrations was obtained with amitriptyline, fluoxetine and tranylcypromine, and the minimum relaxation was obtained with venlafaxine. The relaxation responses were independent of the endothelium.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Saphenous Vein/drug effects , Saphenous Vein/transplantation , Tranylcypromine/pharmacology , Fluoxetine/pharmacology , Amitriptyline/pharmacology , Antidepressive Agents/pharmacology , Reference Values , Vasodilation/drug effects , Endothelium, Vascular/drug effects , Coronary Artery Bypass/methods , Analysis of Variance , Transplants/drug effects , Venlafaxine Hydrochloride/pharmacology , Muscle, Smooth, Vascular/drug effects
11.
Arq. bras. cardiol ; 112(5): 511-523, May 2019. tab, graf
Article in English | LILACS | ID: biblio-1011194

ABSTRACT

Abstract Background: Comparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial. Objective: To conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials. Methods: Electronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05. Results: In the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI. Conclusion: Compared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.


Resumo Fundamento: A comparação entre a intervenção coronária percutânea (ICP) utilizando stents e cirurgia de revascularização do miocárdio (CRM) permanece controversa. Objetivo: Realizar uma revisão sistemática com metanálise da ICP utilizando stents vs. CRM em estudos clínicos randomizados. Métodos: Foram pesquisadas bases de dados eletrônicas para identificar estudos randomizados comparando a ICP com stents vs. CRM em multiarteriais e lesão de tronco de coronária esquerda desprotegida (LTCED). Foram encontrados quinze estudos, e seus resultados foram agrupados. As diferenças entre os estudos foram consideradas significativas com valor de p < 0,05. Resultados: Nos dados agrupados (n = 12.781), a mortalidade em 30 dias e o acidente vascular cerebral (AVC) tiveram menor incidência com a ICP (1% versus 1,7%, p = 0,01; 0,6% versus 1,7%, p < 0,0001); não houve diferença na mortalidade em um e dois anos (3,3% versus 3,7%, p = 0,25; 6,3% versus 6,0%, p = 0,5). A mortalidade em longo prazo favoreceu a CRM (10,6% versus 9,4%, p = 0,04), particularmente nos estudos realizados na era do stent farmacológico (SF) (10,1% versus 8,5%, p = 0,01). Nos diabéticos (n = 3.274), a mortalidade em longo prazo favoreceu a CRM (13,7% versus 10,3%; p < 0,0001). Em seis estudos de LTCED (n = 4.700) não houve diferença na mortalidade em 30 dias (0,6% versus 1,1%, p = 0,15), mortalidade em um ano (3% versus 3,7%, p = 0,18) e mortalidade em longo prazo (8,1% versus 8,1%) entre ICP e CRM; a incidência de AVC foi menor com a ICP (0,3% versus 1,5%; p < 0,001). Diabetes e um escore SYNTAX elevado foram os subgrupos que influenciaram de maneira mais adversa os resultados da ICP. Conclusão: Comparada à CRM, a ICP com stent apresentou menor mortalidade em 30 dias, maior mortalidade tardia e menor incidência de AVC. Diabetes e escore SYNTAX elevado foram os subgrupos que influenciaram de maneira mais adversa os resultados da ICP.


Subject(s)
Humans , Coronary Artery Disease/surgery , Coronary Artery Bypass/methods , Drug-Eluting Stents , Percutaneous Coronary Intervention/methods , Randomized Controlled Trials as Topic , Treatment Outcome
12.
Rev. bras. cir. cardiovasc ; 34(2): 125-135, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990573

ABSTRACT

Abstract Objective: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Dietary Carbohydrates/administration & dosage , Fatty Acids, Omega-3/administration & dosage , Coronary Artery Bypass/methods , Fasting , Postoperative Complications/prevention & control , Reference Values , Time Factors , Blood Glucose/analysis , Insulin Resistance , Coronary Artery Bypass/rehabilitation , Double-Blind Method , Prospective Studies , Reproducibility of Results , Analysis of Variance , Treatment Outcome , Statistics, Nonparametric , Perioperative Period , Length of Stay
13.
Rev. bras. cir. cardiovasc ; 34(2): 156-164, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990568

ABSTRACT

Abstract Objetive: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) improved symptoms and increased survival and quality of life in patients with coronary artery disease. However, it should be the main cause of a complex organic systemic inflammatory response that greatly contributes to several postoperative adverse effects. Methods: We aimed to evaluate heat-shock protein 70 (HSP 70) expression as a morbimortality predictor in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to determine their association with the lactate as a marker of tissue hypoperfusion and the EuroSCORE risk score. This is a prospective, observational study including 46 patients and occurring between May and July 2016. Patients without ventricular dysfunction undergoing myocardial revascularization with extracorporeal circulation were included. They were divided into (1) complicated and (2) uncomplicated postoperative evolution groups. EuroSCORE, lactate levels, and HSP 70 expression and their correlations were determined. Results: Statistical analysis showed that the group with complicated evolution had higher EuroSCORE values than the other group. HSP 70 protein levels were significantly increased in the group with uncomplicated evolution and showed similar results. According to our results, HSP family proteins may be independent predictors of uncomplicated evolution in patients without ventricular dysfunction undergoing CABG with CPB. Conclusion: HSP 70 should be a good discriminator and protection marker for complications in cardiac surgery.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cardiopulmonary Bypass/mortality , Coronary Artery Bypass/mortality , Risk Assessment/methods , HSP70 Heat-Shock Proteins/analysis , Lactic Acid/blood , Preoperative Period , Postoperative Complications/etiology , Biomarkers/analysis , Cardiopulmonary Bypass/methods , Logistic Models , Blotting, Western , Coronary Artery Bypass/methods , Sensitivity and Specificity , Statistics, Nonparametric , Myocardium/pathology
14.
Rev. bras. cir. cardiovasc ; 34(2): 142-148, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-990566

ABSTRACT

Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Registries/statistics & numerical data , Coronary Artery Bypass/methods , Coronary Artery Bypass/statistics & numerical data , Brazil , Coronary Artery Bypass/adverse effects , Cross-Sectional Studies , Treatment Outcome , Hospital Mortality , Intraoperative Complications
15.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 316-318, Mar. 2019.
Article in English | LILACS | ID: biblio-1003030

ABSTRACT

SUMMARY Coronary artery bypass graft (CABG) is a consolidated treatment in patients with coronary artery disease (CAD) for both symptom control and improvement of prognosis. The patency of venous grafts is still the most vulnerable point of the surgical treatment since it presents a high prevalence of occlusion both in the immediate postoperative period and in the long-term follow-up. Aspirin plays a well-established role in this setting, and for a long time, clopidogrel use has been restricted to patients allergic to aspirin. Recently, subgroup analyses of studies with different anti-platelet therapies have shown reduced mortality and cardiovascular events in patients on dual anti-platelet antiplatelet therapy (DAPT) undergoing CABG, although such studies have not been designed to evaluate this patient profile. However, there is still an insufficient number of randomized studies using DAPT in this context, resulting in a disagreement between the European and American cardiology societies guidelines regarding their indication and generating doubts in clinical practice.


RESUMO A cirurgia de revascularização miocárdica (CRM) é tratamento fundamental em pacientes com doença arterial coronariana (DAC) tanto para controle de sintomas quanto para melhora do prognóstico. A patência dos enxertos venosos ainda hoje é o ponto mais vulnerável do tratamento cirúrgico, por apresentar alta prevalência de oclusão tanto no pós-operatório imediato como no seguimento em longo prazo. A aspirina tem papel bem estabelecido neste cenário e, por muito tempo, o uso do clopidogrel ficou restrito a pacientes alérgicos a aspirina. Recentemente, análises de subgrupos de estudos com diferentes terapias antiplaquetárias demonstraram redução de mortalidade e eventos cardiovasculares em pacientes em uso de dupla antiagregação plaquetária (Dapt) submetidos à CRM, ainda que tais estudos não tenham sido desenhados para avaliar este perfil de pacientes. Contudo, há ainda uma quantidade insuficiente de estudos randomizados com uso de Dapt nesse contexto, resultando em uma discordância entre as diretrizes europeia e americana de cardiologia quanto à sua indicação e gerando dúvidas na prática clínica.


Subject(s)
Humans , Vascular Patency/drug effects , Platelet Aggregation Inhibitors/therapeutic use , Coronary Artery Bypass/methods , Graft Occlusion, Vascular/prevention & control , Coronary Artery Disease/surgery , Aspirin/therapeutic use , Coronary Artery Bypass/adverse effects , Treatment Outcome , Clopidogrel/therapeutic use , Ticagrelor/therapeutic use
16.
Säo Paulo med. j ; 137(1): 66-74, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004734

ABSTRACT

ABSTRACT BACKGROUND: The pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC). DESIGN AND SETTING: Randomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil. METHODS: 48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated. RESULTS: After adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes. CONCLUSION: There was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc V1111.1159.4447.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Drainage/instrumentation , Drainage/methods , Coronary Artery Bypass/methods , Pleural Cavity/surgery , Pleural Effusion/etiology , Pleural Effusion/prevention & control , Time Factors , Coronary Artery Disease/surgery , Pain Measurement , Drainage/adverse effects , Coronary Artery Bypass/adverse effects , Reproducibility of Results , Treatment Outcome , Elective Surgical Procedures/methods , Statistics, Nonparametric , Extracorporeal Circulation/methods , Maximal Respiratory Pressures
17.
Rev. bras. cir. cardiovasc ; 34(1): 57-61, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985249

ABSTRACT

Abstract Objective: To evaluate the association between serum vitamin D (vitD) level and SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score (SS). Methods: The medical records of consecutive patients, who underwent coronary artery bypass graft surgery, were retrospectively reviewed. The study group consisted of 158 patients. Biochemical, clinical, and echocardiographic parameters and SS were evaluated in all patients. The patients were divided into 2 groups according to SS (≥23= high, <23= low). Results: The high SYNTAX score (HSS) group was older and had higher body mass index, C-reactive protein (CRP), low-density lipoprotein, and fasting plasma glucose level than the low SYNTAX score (LSS) group. The HSS group had lower high-density lipoprotein and vitD level than the LSS group. The HSS group had a higher prevalence of diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), and current smoking patients than the LSS group. On univariate analysis, age, HT, DM, HL, smoking, CRP, and serum vitD level were associated with HSS. On multivariate analysis, HT, DM, and HL were independent predictors of HSS (odds ratio [OR]: 2.137, 95% confidence interval [CI]: 1.468-2.935, P<0.001; OR: 3.559, 95% CI: 2.763-5.927, P<0.001; OR: 2.631, 95% CI: 1.529-3.438, P<0.001; respectively). Conclusion: In our study, we have found out that HT, DM, and HL were independent predictors of HSS. Serum vitD level was not found to be an independent predictor of HSS.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Vitamin D/blood , Coronary Artery Disease/blood , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/methods , Coronary Angiography/methods , Risk Assessment/methods , Reference Values , Vitamin D Deficiency/blood , Coronary Artery Disease/etiology , Cross-Sectional Studies , Multivariate Analysis , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Diabetes Complications , Percutaneous Coronary Intervention/methods , Hyperlipidemias/complications , Hypertension/complications
18.
Rev. bras. cir. cardiovasc ; 34(1): 114-117, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985245

ABSTRACT

Abstract Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.


Subject(s)
Humans , Male , Middle Aged , Thromboangiitis Obliterans/complications , Coronary Artery Disease/etiology , Coronary Occlusion/etiology , Saphenous Vein/transplantation , Thromboangiitis Obliterans/surgery , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/methods , Coronary Angiography/methods , Coronary Occlusion/surgery , Coronary Occlusion/diagnostic imaging , Computed Tomography Angiography/methods , Mammary Arteries/surgery
19.
Rev. bras. cir. cardiovasc ; 34(1): 93-97, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985242

ABSTRACT

Abstract The best treatment for patients with ischemic heart failure (HF) is still on debate. There is growing evidence that coronary artery bypass graft (CABG) benefits these patients. The current recommendations for revascularization in this context are that CABG is reasonable when it comes to decreasing morbidity and mortality rates for patients with severe left ventricular dysfunction (ejection fraction <35%), and significant coronary artery disease (CAD) and should be considered in patients with operable coronary anatomy, regardless whether or not there is a viable myocardium (class IIb). Percutaneous coronary intervention (PCI) does not have enough data to allow the panels to reach a conclusion. The Korean Acute Heart Failure registry (KorAHF) had its data released recently, showing that patients with acute HF who underwent CABG had lower death rates, more complete revascularization and less adverse outcomes compared with patients treated with PCI. Recent ESC/EACTS guidelines on myocardial revascularization clearly recommended CABG as the first choice of revascularization strategy in patients with multivessel disease and acceptable surgical risk to improve prognosis in this scenario of left ventricular dysfunction. However, a high peri-procedural risk must be compared with the benefit of late mortality, and pros and cons of each strategy (either PCI or CABG) must be weighed in the decision-making process. Spurred on by the publication of the above-mentioned article and the release of new guidelines, we went on to write an overview of the current practice of state-of-the-art coronary revascularization options in patients with HF.


Subject(s)
Humans , Coronary Artery Bypass/standards , Myocardial Ischemia/surgery , Percutaneous Coronary Intervention/standards , Heart Failure/surgery , Coronary Artery Bypass/methods , Practice Guidelines as Topic , Ventricular Dysfunction, Left/surgery , Risk Assessment , Evidence-Based Medicine , Percutaneous Coronary Intervention/methods
20.
Rev. bras. cir. cardiovasc ; 34(1): 98-100, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985241

ABSTRACT

Abstract With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.


Subject(s)
Humans , Male , Aged, 80 and over , Saphenous Vein/transplantation , Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Reproducibility of Results , Treatment Outcome , Coronary Angiography/methods , Coronary Stenosis/surgery , Computed Tomography Angiography/methods
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