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ORIGINAL ARTICLE

Myocardial revascularization without cardiopulmonary bypass: results of 15 years' experience

Ênio BuffoloI; José Carlos S AndradeI; João Nelson R BrancoI; Carlos TelesI; Walter José GomesI; Luciano F AguiarI; José Honório PalmaI

DOI: 10.1590/S0102-76381996000400002

ABSTRACT

Myocardial revascularization without cardiopulmonary bypass is now a subject of increasing interest. The purpose of this paper is to present the results obtained during 15 years of experience. From September 1981 till March 1996,1549 patients we operated on without the use of cardiopulmonary bypass with an applicability of this alternative around 18% of the total revascularized patients in this period. The ages varied from 28 to 86 years (medium 57) with 1126 males and 423 females. The number of grafts varied from 1 to 5 (medium 1.7 grafts/patient). The technique did not constitute special limitation to use arterial grafts. The thoracic internal arteries were used 1140 times. In 1515 patients the revascularization was achieved through medsternotomy and in 34 through a minor left anterior thoracotomy. The mortality rate was 2.4% (38/1549) the main primary cause of death, low cardiac output in patients operated under acute ischemia after failed angioplasty or evolving mycardial infarction. In 8 patients the revascularization was performed under intraaortic balloon pump. The results of this 15 years experience permit the conclusion that myocardial revascularization without extracorporeal circulation is an excelent alternative of surgical treatment of coronary artery disease for a subset of patients with lower mortality and morbidity being specially indicated in high risk patients.

RESUMO

A revascularização miocárdica sem circulação extracorpórea agora se constitui numa alternativa de tratamento cirúrgico de cardiopatia isquêmica de interesse crescente. O objetivo deste trabalho é apresentar os resultados obtidos ao longo de 15 anos de experiência ininterrupta. De setembro de 1981 a março de 1996, 1549 pacientes foram operados sem o auxílio do coração-pulmão artificial, o que constitui cerca de 18% do total de pacientes operados no período. As idades variaram de 28 a 86 anos, oscilando em torno de 57 anos, sendo 1126 do sexo masculino e 423 do feminino. O número de pontes variou de 1 a 5, com média de 1,7 pontes/paciente. A técnica não constituiu problema especial para o emprego de enxertos arteriais, sendo as artérias torácicas internas utilizadas em 1140 artérias coronárias. Em 1515 pacientes a via de acesso foi a esternotomia mediana e, em 34, a toracotomia anterior esquerda mínima. A mortalidade operatória global foi de 2,4% (38/1549), sendo a principal causa o mau débito cardíaco em pacientes operados em isquemia aguda, sendo 8 sob auxílio de balão intra-aórtico. Os resultados desta experiência permitem concluir que a revascularização do miocárdio sem circulação extracorpórea é uma excelente alternativa de revascularização para determinado subgrupo de pacientes, oferecendo baixa mortalidade e morbidade pós-operatória, sendo especialmente indicada em pacientes com complicações clínicas pré-existentes e de maior risco operatório.
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