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1.
Heart Surg Forum ; 4(2): 147-50; discussion 150-1, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11544627

RESUMO

BACKGROUND: Mortality in intensive care units among patients with acute myocardial infarction (AMI) may reach 10-20%, and with cardiogenic shock 50-100%. Moreover, the mortality rate at one year is about 15%, and 25-40% of survivors suffer from recurrent angina. In this report, we describe the surgical results of high-risk patients with AMI who were operated on within 96 hours of the infarction. METHODS: From January 1998 through July 2000, among 348 patients who underwent off-pump coronary surgery at the [institution removed for review], 26 consecutive patients (7.5%) were operated on for acute myocardial infarction. Patients with AMI secondary to failed percutaneous transluminal coronary angioplasty (PTCA) were not included in the study group. Four patients (15.3%) were admitted to surgery in cardiogenic shock, four (15.3%) with life-threatening ventricular arrhythmias, and one patient with a rupture of the posterior left ventricular wall. Repeated ventricular fibrillations were recorded in the operating room in three patients (11.5%). In 16 patients, conventional off-pump coronary artery bypass (OPCAB) surgery through median sternotomy was performed using 1-3 saphenous vein grafts, and 10 patients underwent minimally invasive coronary artery bypass (MICAB) with the endoscopic dissection of the left internal mammary artery (LIMA) for single- or double-vessel revascularization. RESULTS: A mean time of 620 +/- 45 minutes (range 180 min. to 96 hours) was recorded between first symptoms and surgical reperfusion. The mortality rate was 7.7% (N = 2). Major complications, which included cerebrovascular accident (CVA), were observed in one patient and resulted in a morbidity rate of 3.8%. The mean number of grafts per patient was 1.8. Twenty-two patients (84.6%) underwent complete revascularization, but four patients (15.4%) with multivessel coronary disease and unstable hemodynamics received incomplete revascularization as a result of not grafting the obtuse marginal or posterior lateral branches of the circumflex coronary artery. In the early postoperative period, all patients were asymptomatic. Early angiographic study was undertaken from five to fifteen days postoperatively in 12 patients (46%); the angiography demonstrated the patency of all studied grafts and the recovery of left ventricular function. CONCLUSION: Off-pump coronary surgery after AMI can be performed with an acceptable mortality rate and low risk of major complications, and offers prospects for early rehabilitation.


Assuntos
Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Adulto , Idoso , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Resultado do Tratamento
2.
Ann Thorac Surg ; 68(4): 1552-4, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10543567

RESUMO

BACKGROUND: The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. METHODS AND RESULTS: The right gastroepiploic artery was harvested endoscopically through three troacars in 46 human cadavers. Then, a 5-cm hole was made in the diaphragm to expose the right coronary artery. With the help of two vacuum pods, we fixed a site of the right coronary artery and made a right gastroepiploic artery-right coronary artery anastomosis. In 20 cases, continuous Prolene suture was used, and in 26 experiments, we applied a sutureless technique. Twenty-three anastomosis were patent. CONCLUSIONS: Despite the low patency rate, the transabdominal approach of totally endoscopic bypass grafting is promising and demands further investigation.


Assuntos
Ponte de Artéria Coronária/instrumentação , Endoscópios , Endoscopia , Anastomose Cirúrgica/instrumentação , Artérias/transplante , Estudos de Viabilidade , Humanos , Instrumentos Cirúrgicos
3.
Heart Surg Forum ; 2(4): 305-9, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-11276492

RESUMO

BACKGROUND: Interest in minimally invasive coronary artery bypass (MICAB) grafting and the MICAB experience have been increasing. The purpose of this study was to develop the multivessel minimally invasive coronary revascularization technique and to estimate the effectiveness of the endoscopic support in this operation. METHODS: From January 1998 through April 1999, 190 patients (ages 38 to 72 years) underwent coronary revascularization without cardiopulmonary bypass. Among them, 69 patients (55 males, 14 females) underwent minimally invasive coronary revascularization, from 1 to 3 vessels, through minithoracotomy and ministernotomy with endoscopically dissected internal mammary artery, gastroepiploic artery, and composite grafts. Preoperative risk factors included unstable angina (n = 15), reoperations (n = 8), low ejection fraction (n = 14), renal insufficiency (n = 4), chronic obstructive pulmonary disease (n = 6), cerebrovascular accident (n = 2), diffuse atherosclerosis (n = 4) and diabetes mellitus (n = 7). RESULTS: The operative mortality was 1.5% (1/69). Morbidity included wound infections (n = 1), reoperation for management of bleeding (n = 1), acute graft occlusion (n = 1), perioperative myocardial infarction (n = 1). The number of grafts placed in 69 patients was as follows: single, 54; double, 10; triple, 5. Postoperative angiography and Doppler flow assessment of the coronary anastomoses performed in 22 patients (30%) showed that 97% were patent. CONCLUSIONS: The minimally invasive direct coronary artery bypass grafting operation is safe and effective. Endoscopic support makes the use of minimally invasive technology possible in patients with multivessel coronary disease and makes this operation less traumatic.


Assuntos
Ponte de Artéria Coronária/instrumentação , Doença das Coronárias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Toracoscópios , Adulto , Idoso , Ponte Cardiopulmonar , Doença das Coronárias/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Anastomose de Artéria Torácica Interna-Coronária/instrumentação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Taxa de Sobrevida
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