[Coronary artery bypass surgery using the mini-extracorporeal circulation system: a Spanish unit's experience]. / Cirugía coronaria con mini-circulación extracorpórea: experiencia de un grupo en España.

INTRODUCTION AND OBJECTIVES: The increasing use of percutaneous interventions has resulted in a significant reduction in coronary artery bypass grafting. Today, patients referred for surgery are older, have more comorbidities, and have undergone previous percutaneous intervention, and their ventricular function is poorer. As a result, surgery has attempted to improve its results by adopting a number of different strategies. The aim of this study was to investigate and describe one cardiac surgery unit's initial experience with coronary artery bypass grafting using mini-extracorporeal circulation (MECC), which had become its technique of choice. METHODS: A retrospective analysis of 408 patients who underwent isolated coronary artery bypass grafting using MECC between January 2004 and April 2007 was carried out. Of the 408, 329 (80.6%) were men, their mean age was 63.5 years (28-83 years), 63% had hypertension, 49.3% had diabetes, 69% had hyperlipidemia, and 52% were smokers. RESULTS: The surgical mortality rate predicted by the logistic EuroSCORE was 3.7% (range, 1-38). Overall, 34% of patients had left main coronary artery disease and 87% had three-vessel disease. In 74%, complete revascularization was carried out using a mean of 2.97 (range, 1-7) grafts per patient. A mammary artery graft was used in all cases. The in-hospital mortality rate was 0.74%. There were few postoperative complications: 0.98% of patients required further surgery because of bleeding, 3.4% had a significantly elevated troponin-I level, 6.4% developed kidney failure, and 0.5% suffered a stroke. CONCLUSIONS: Coronary artery bypass grafting using MECC enabled complete revascularization to be performed in most patients, and morbidity and mortality rates were low.

Cirugía coronaria con mini-circulación extracorpórea: experiencia de un grupo en España / Coronary Artery Bypass Surgery Using the Mini-Extracorporeal Circulation System: A Spanish Unit's Experience

Introducción y objetivos. El incremento del intervencionismo percutáneo ha conllevado una disminución significativa de la cirugía coronaria. El perfil del paciente coronario que se remite a cirugía es más añoso, con mayor comorbilidad, peor función ventricular y con procedimientos percutáneos previos. En este sentido la cirugía ha intentado mejorar sus resultados desde varios frentes de actuación. El objetivo es analizar y describir la experiencia inicial de la cirugía coronaria con mini-circulación extracorpórea (MCEC) en un grupo de cirugía cardiaca en el que se ha convertido en técnica de elección. Métodos. Entre enero de 2004 y abril de 2007, se analizó de forma retrospectiva a 408 pacientes sometidos a cirugía coronaria aislada con MCEC, 329 (80,6%) varones, con media (intervalo) de edad de 63,5 (28-83) años. Un 63% tenía hipertensión; el 49,3%, diabetes; el 69%, dislipemia, y el 52% eran fumadores. Resultados. El EuroSCORE logístico (mortalidad esperada) era del 3,7% (1%-38%). El 34% de los pacientes tenían afección del tronco común y el 87%, enfermedad de 3 vasos. En el 74% de los casos se realizó revascularización completa, con un número medio de injertos de 2,97 (1-7). Se utilizó injerto de mamaria en el 100% de los casos. La mortalidad hospitalaria fue del 0,74%. Las complicaciones postoperatorias fueron pocas: el 0,98% precisó reintervención por sangrado, en el 3,4% se elevó la troponina I de forma significativa, en el 6,4% se desarrolló insuficiencia renal y el 0,5% tuvo accidente vascular cerebral. Conclusiones. La cirugía coronaria con MCEC permite realizar una revascularización completa en la mayoría de los pacientes, con buenos resultados de morbimortalidad (AU)

Introduction and objectives. The increasing use of percutaneous interventions has resulted in a significant reduction in coronary artery bypass grafting. Today, patients referred for surgery are older, have more comorbidities, and have undergone previous percutaneous intervention, and their ventricular function is poorer. As a result, surgery has attempted to improve its results by adopting a number of different strategies. The aim of this study was to investigate and describe one cardiac surgery unit's initial experience with coronary artery bypass grafting using mini-extracorporeal circulation (MECC), which had become its technique of choice. Methods. A retrospective analysis of 408 patients who underwent isolated coronary artery bypass grafting using MECC between January 2004 and April 2007 was carried out. Of the 408, 329 (80.6%) were men, their mean age was 63.5 years (28-83 years), 63% had hypertension, 49.3% had diabetes, 69% had hyperlipidemia, and 52% were smokers. Results. The surgical mortality rate predicted by the logistic EuroSCORE was 3.7% (range, 1-38). Overall, 34% of patients had left main coronary artery disease and 87% had three-vessel disease. In 74%, complete revascularization was carried out using a mean of 2.97 (range, 1-7) grafts per patient. A mammary artery graft was used in all cases. The in-hospital mortality rate was 0.74%. There were few postoperative complications: 0.98% of patients required further surgery because of bleeding, 3.4% had a significantly elevated troponin-I level, 6.4% developed kidney failure, and 0.5% suffered a stroke. Conclusions. Coronary artery bypass grafting using MECC enabled complete revascularization to be performed in most patients, and morbidity and mortality rates were low (AU)