Assuntos
Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Redes Comunitárias , Dissecação , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/mortalidade , Doenças da Aorta/fisiopatologia , Protocolos Clínicos/normas , Dissecação/métodos , Dissecação/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Análise de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The use of aortic connectors for proximal saphenous vein bypass graft anastomoses eliminates the need for aortic clamping during coronary artery bypass grafting (CABG) and may reduce the incidence of stroke in the elderly and in patients with severe aortic atherosclerosis. METHODS AND RESULTS: We studied 74 consecutive patients who received the Symmetry Bypass System aortic connector at the time of CABG. A total of 131 of 144 proximal vein graft anastomoses were performed with this device. The left internal mammary artery was used in 62 patients, and 61 patients had "off-pump" coronary revascularization. A total of 11 patients were readmitted with chest pain consistent with unstable angina 173+/-39 days after CABG. Five of the 11 patients had previous in-stent restenosis before CABG. At angiography, 20 saphenous vein bypass grafts containing 19 connectors were found to have severe stenosis (n=12) or occlusion (n=6) and were treated with angioplasty and stenting or medical therapy. Seven of 11 patients were readmitted 76+/-11 days later with recurrent chest pain and were found to have severe stenosis at the previously stented connector site. Six patients underwent angioplasty followed by brachytherapy. Three of these patients redeveloped chest pain and were readmitted 151+/-71 days later. Two patients were started on oral Rapamune, and one patient underwent redo-CABG. CONCLUSIONS: Eleven of 74 patients who received aortic connectors at the time of CABG developed symptomatically significant stenosis or occlusion at the connector site shortly after CABG, requiring multiple repeat interventions, including brachytherapy.
Assuntos
Aorta , Prótese Vascular , Ponte de Artéria Coronária/métodos , Veia Safena , Idoso , Angioplastia Coronária com Balão , Aorta/cirurgia , Prótese Vascular/efeitos adversos , Prótese Vascular/estatística & dados numéricos , Braquiterapia , Dor no Peito/etiologia , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Reestenose Coronária/diagnóstico , Reestenose Coronária/cirurgia , Falha de Equipamento/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Terapia a Laser , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Recidiva , Reoperação , Veia Safena/cirurgia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed. Using a commercially available suction stabilization device and the surgical and anesthetic techniques described herein, off-pump coronary revascularization was accomplished with results comparable to the on-pump approach.
