Navegando por Palavras-chave "Coronary artery bypass"
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- ItemAcesso aberto (Open Access)Avaliação microscópica e ultra-estrutural do endotélio de veia safena preparada pela técnica no touch(Sociedade Brasileira de Cirurgia Cardiovascular, 2008-09-01) Silva, Virgílio Figueiredo [UNIFESP]; Ishigai, Márcia Marcelino de Souza [UNIFESP]; Freymüller-Haapalainen, Edna [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Gaia, Diego Felipe [UNIFESP]; Gabriel, Edmo Atique [UNIFESP]; Romão, Renata Aparecida Leonel [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Saphenous vein grafts (SV) used in coronary artery bypass grafting have a limited life and vein occlusion may be the final adverse effect. Efforts to develop new techniques to harvest the saphenous vein may improve the viability of the graft. METHODS: Twenty patients were randomly divided into two groups with the objective of evaluating the vascular endothelium. The No Touch (NT) technique consists in removing the saphenous vein with perivascular tissue. The conventional technique consists in harvesting with in situ removal of the perivascular tissue. The standard saphenous vein harvesting procedure used bridged incisions. Characteristics of the vein were considered. Evaluation of the endothelium was achieved by electron microscopy and histologic analysis using hematoxylin eosin staining. The Picrosirius and Masson Trichrome methods were used to analyze subendothelial collagen. RESULTS: Electron microscopy demonstrated that the NT Group had larger non-denudated endothelial areas as well as a smaller number of degraded cells. Histological analysis showed the form and integrity of the saphenous vein layers. A larger amount of collagen fibers were identified in the NT Group. CONCLUSIONS: The NT technique better preserves the saphenous vein endothelium suggesting a more viable graft in the long term.
- ItemSomente MetadadadosEfeitos da ventilação mecânica não invasiva com pressão positiva na resposta inflamatória e perfusão tecidual após cirurgia de revascularização do miocárdio: ensaio clínico controlado e randomizado(Universidade Federal de São Paulo (UNIFESP), 2018-10-31) Nasrala, Mara Lilian Soares [UNIFESP]; Gomes, Walter Jose [UNIFESP]; Guizilini, Solange [UNIFESP]; http://lattes.cnpq.br/1563905009199506; http://lattes.cnpq.br/9877675594064089; http://lattes.cnpq.br/1673097544233251; Universidade Federal de São Paulo (UNIFESP)Objective: To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative following coronary artery bypass graft in patients with preserved left ventricular function. Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The ENPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05).
- ItemAcesso aberto (Open Access)Functional status change in older adults undergoing coronary artery bypass surgery(Associação Paulista de Medicina - APM, 2011-03-01) Guimarães, Márcio Niemeyer Martins De Queiroz; Almada Filho, Clineu De Mello [UNIFESP]; Quinta D'Or Hospital; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Increased life expectancy has resulted in growing numbers of elderly patients undergoing heart surgery. This study aimed to identify changes in functional status among older adults undergoing coronary artery bypass grafting. DESIGN AND SETTING: Prospective observational cohort study conducted at a level IV private hospital in Brazil. METHODS: Patients were assessed using the Katz and Lawton scales and the Functional Independence Measure before admission, at hospital discharge and one month after discharge. Repeated-measurement analysis of variance was used. RESULTS: Two patients died during hospitalization. Among the 31 patients included, the Functional Independence Measure ranged from 121.7 ± 7.4 (pre-admission) to 91.1 ± 20.5 (discharge) and 109.0 ± 21.7 (one month after discharge); the Katz scale from 5.92 ± 0.32 to 4.18 ± 1.04 and 5.13 ± 1.30; and the Lawton scale from 24.3 ± 4.6 to 12.8 ± 2.0 and 16.5 ± 4.6 (P = 0.0001). When subgroups with (18) and without (13) complications were compared, the Functional Independence Measure (P = 0.085) showed a trend, although not significantly, toward recovery one month after discharge. Delirium and blood transfusion were the intercurrent events found. There was a correlation between the scales and age (P = 0.008), APACHE II (P = 0.051), EuroSCORE (P = 0.064), intensive care unit stay (P = 0.024) and overall hospital length of stay (P = 0.040). CONCLUSION: The Functional Independence Measure proved to be a promising tool for monitoring the functional status of elderly patients undergoing coronary artery bypass grafting, especially in the subgroup with complications.
- ItemSomente MetadadadosGiant Aneurysm of Saphenous Vein Bypass for Right Coronary after Angioplasty(Arquivos Brasileiros Cardiologia, 2012-08-01) Albuquerque, Mauro Guimaraes; Farran, Jorge Alcantara; Pereira, Carlos Alberto Pires [UNIFESP]; Romano, Edson Renato; Brotto, Isabela Neto Macri; Romano, Marcelo Luz Pereira; Hosp Coracao HCor; Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)Medida do fluxo intraoperatório com fluxômetro TTFM nos enxertos coronários: resultados de amostra nacional(Sociedade Brasileira de Cirurgia Cardiovascular, 2012-09-01) Succi, José Ernesto [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Succi, Guilherme de Menezes; Kim, Hyong Chun [UNIFESP]; Paredes, Jorge Edwin Morocho; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Bandeirantes; Instituto de Cardiologia Dante PazzaneseOBJECTIVE: To evaluate intraoperative graft patency and identify grafts under risk of early occlusion. METHODS: Fifty four patients were submitted to coronary artery bypass surgery and the graft flow was assessed by the Flowmeter (Medtronic Medistim), which utilizes the TTFM method. Three patients had left main disease and 48 had normal or mildly reduced left ventricular function. RESULTS: In hospital mortality was 3.7% (two patients), one for mesenteric thrombosis and one due to cardiogenic chock. Seventeen patients (34%) were submitted to off pump CABG. Arterial Graft flow measures ranged from 8 to 106 ml/min (average 31.14 ml/min), and venous grafts flow ranged from 9 to 149 ml/min (average 50.42 ml/min). CONCLUSION: Flowmeter use represents higher safety both for patients and surgeons. Even under legal aspects, the documentation provided by the device can avoid future questionings.
- ItemAcesso aberto (Open Access)Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function(Faculdade de Medicina / USP, 2011-01-01) Caputti, Guido Marco [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Gaia, Diego Felipe [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: Patients with coronary artery disease and left ventricular dysfunction have high mortality when kept in clinical treatment. Coronary artery bypass grafting can improve survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study is to compare patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft with or without cardiopulmonary bypass. METHODS: From January 2001 to December 2005, 217 nonrandomized, consecutive, and nonselected patients with an ejection fraction less than or equal to 20% underwent coronary artery bypass graft surgery with (112) or without (off-pump) (105) the use of cardiopulmonary bypass. We studied demographic, operative, and postoperative data. RESULTS: There were no demographic differences between groups. The outcome variables showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary bypass group and 3.8% in the off-pump group. Postoperative complications were statistically different (cardiopulmonary bypass versus off-pump): total length of hospital stay (days)-11.3 vs. 7.2, length of ICU stay (days)-3.7 vs. 2.1, pulmonary complications-10.7% vs. 2.8%, intubation time (hours)-22 vs. 10, postoperative bleeding (mL)-654 vs. 440, acute renal failure-8.9% vs. 1.9% and left-ventricle ejection fraction before discharge-22% vs. 29%. CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass in selected patients with severe left ventricular dysfunction is valid and safe and promotes less mortality and morbidity compared with conventional operations.
- ItemAcesso aberto (Open Access)Risco de débito cardíaco diminuído no perioperatório de revascularização do miocárdio(Universidade Federal de São Paulo (UNIFESP), 2014) Santos, Eduarda Ribeiro dos [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; http://lattes.cnpq.br/3089430786971948; http://lattes.cnpq.br/4512824283507432; Universidade Federal de São Paulo (UNIFESP)O diagnóstico de enfermagem Risco de Débito Cardíaco Diminuído está em fase de sustentação científica e a identificação dos seus fatores de risco carece de estudos. Objetivos: identificar os fatores de risco perioperatório do diagnóstico de enfermagem Risco de Débito Cardíaco Diminuído no pós-operatório imediato dos pacientes submetidos à cirurgia de revascularização do miocárdio (CRM). Método: estudo observacional analítico com desenho de coorte prospectiva. A amostra foi composta por 257 pacientes submetidos à CRM. A análise estatística foi realizada por meio de regressão logística simples, múltipla e teste Exato de Fisher Resultados: a maioria dos pacientes submetidos à CRM foi de indivíduos do sexo masculino, com idade igual ou superior a 60 anos, hipertensos, pré-obesos, diabéticos e tabagistas. Dos 257 pacientes da amostra, 195 apresentaram diminuição do débito cardíaco no pós-operatório imediato. Foram identificados como fatores de risco do diagnóstico de enfermagem Risco de Débito Cardíaco Diminuído: idade ≥60 anos; diminuição da fração de ejeção ventricular; não uso da artéria radial; balanço hídrico positivo; arritmia pós-operatória. Os valores preditos pelo modelo final foram avaliados quanto à diminuição do débito cardíaco, por meio da curva - Receiver Operating Characteristic - ROC, que forneceu área sob a curva de 0,815 (IC 95%: 0,751 a 0,880; p<0,001), o que indica um bom desempenho do modelo para a predição da diminuição do débito cardíaco. Com o ponto de corte de 0,835 para o valor predito de diminuição do débito cardíaco para o modelo, obteve-se sensibilidade de 62,9% e especificidade de 87,2% com o modelo múltiplo ajustado. Dentre as variáveis que não puderam ser analisadas mediante regressão logística, foi aplicado o teste Exato de Fischer, obtendo-se como fatores de risco: falência ventricular; reabordagem cirúrgica; reabordagem cirúrgica por sangramento.
- ItemSomente MetadadadosVasoplegic syndrome after off-pump coronary artery bypass surgery: a rising threat(Elsevier B.V., 2009-06-01) Gomes, Walter J. [UNIFESP]; Evora, Paulo R.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)