Off-pump myocardial revascularization: Critical analysis of 23 years' experience in 3,866 patients

Off-pump myocardial revascularization: Critical analysis of 23 years' experience in 3,866 patients

Autor Buffolo, Enio Autor UNIFESP Google Scholar
Branco, João Nelson Rodrigues Autor UNIFESP Google Scholar
Gerola, Luís Roberto Autor UNIFESP Google Scholar
Aguiar, Luciano Figueiredo Autor UNIFESP Google Scholar
Teles, Carlos Alberto Autor UNIFESP Google Scholar
Fonseca, José Honório de Almeida Palma da Autor UNIFESP Google Scholar
Catani, Roberto Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo Background. Surgical myocardial revascularization without cardiopulmonary bypass (CPB) is not new, with the first consecutive series of patients appearing in the early eighties. There has been increased interest in this alternative approach, especially in patients with comorbidities. There is controversy regarding advantages, risks, and usefulness of this method of myocardial revascularization. We herein report a consecutive series of 3,866 patients, from the first case in September 1981 to the last in November 2004, analyzing applicability, mortality, morbidity, and surgical technique.Methods. From September 1981 to November 2004, 3,866 consecutive patients were revascularized without CPB. This figure represents an overall applicability of 30.8% considering a total of 12,553 revascularization procedures performed during this time. There were 2,822 males (73%) with ages from 12 to 93 years (median, 62 14). Mean grafts per patient was 1.9, and the internal mammary artery was used in 87.3% of cases. the main indications for surgery were chronic coronary insufficiency (89% of cases) and failure of angioplasty or stenting.Results. Hospital mortality was 1.9%, with low incidence of cerebrovascular accident (5 cases in the entire series). Morbidity, considering major postoperative complications, occurred in 12.5% of the patients. the applicability of the off-pump technique was 18% of cases in the beginning of our experience, increasing to 49% in the last 5 years with the use of stabilizers and maneuvers to expose posterior coronary branches.Conclusions. Off-pump coronary surgery is an alternative method of myocardial revascularization that should be considered for every patient. the preference of this technique over conventional revascularization should be based on the surgeon's own experience, on the patient's preoperative condition and on the coronary anatomy. Off-pump myocardial revascularization represents an important development in coronary artery surgery. Over the years it has evolved into a valid form of surgery with the same safety as the conventional operation and with more advantages in high risk patients.
Idioma Inglês
Data de publicação 2006-01-01
Publicado em Annals of Thoracic Surgery. New York: Elsevier B.V., v. 81, n. 1, p. 85-89, 2006.
ISSN 0003-4975 (Sherpa/Romeo, fator de impacto)
Publicador Elsevier B.V.
Extensão 85-89
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000234585400011
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