RESUMO
OBJECTIVE: The main purpose of this article is to evaluate an impact of epicardial ligation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing off-pump coronary artery bypass grafting (OPCAB) on the development of ischemic stroke and mortality. METHODS: From 2009 to 2013, a total of 125 patients (86.4% men, mean age 64 ± 7 years, 95% confidence interval: 61-65 years) received a combined OPCAB and LAA ligation because of coronary artery disease and AF. All the subjects were divided into two groups: group 1 (n = 57)-LAA ligation during OPCAB, group 2 (n = 68) without LAA ligation during OPCAB. Primary endpoints were postoperative incidence of ischemic stroke and mortality. RESULTS: No difference in the number of ischemic stroke (0 vs. 5.9%) and death (0 vs. 4.4%) in both groups during the hospital period (p > 0.05). Median overall follow-up was 41 (22-61) months: without difference for groups (p > 0.05). During follow-up, there was a difference in the number of ischemic stroke (0 vs. 17.6%, p < 0.001), while there was no difference in mortality in two study groups (5.3 vs. 16.2%, p > 0.05). CONCLUSION: Epicardial ligation of LAA during OPCAB in patients with AF may reduce the risk of ischemic stroke in long-term follow-up and does not affect the mortality.
Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , AVC Isquêmico/prevenção & controle , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Bases de Dados Factuais , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/etiologia , AVC Isquêmico/mortalidade , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Pocket hematoma (PH) is a common complication of implantations of cardiac electrophysiological devices with occurring at a particularly high rate in patients on oral anticoagulation or antiplatelet treatment. Different pharmacological agents with hemostatic effect are used to avoid PH. We supposed that the vasoconstrictor effects of epinephrine may reduce bleeding extent and be effective in prevention of PH. Maitre is the first clinical trial conducted with an aim to show the safety and efficacy of epinephrine in PH prophylaxis. We randomized 133 patients to receive either epinephrine or saline solution, which were added to a local anesthetic administered during pacemaker implantation. In cases of diffuse bleeding a method of pocket drainage was effectively used. Results showed that risk of PH was significantly higher in the group receiving epinephrine. We conclude that a local epinephrine effect may lead to a false impression of adequate hemostasis and force a surgeon to refuse from drainage insertion.
