Surgical treatment of patients with heart failure through myocardial revascularization, ventricular reconstruction, and mitral valve surgery

Universidade Federal de São Paulo (UNIFESP) EPMUNIFESP, EPMSciEL

Risk scores: coronary artery bypass grafting with and without cardiopulmonary bypass

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Congratulations, Dr. Braile

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Myocardial revascularization without extracorporeal circulation

Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Estudio SYNTAX, de la evidencia a la desobediencia

Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, BrazilHosp Modelo, Serv Cirugia Cardiaca, La Coruna, SpainUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, BrazilWeb of Scienc

Can coronary artery bypass surgery provide equivalent outcomes after percutaneous coronary interventions?

UNIFESP-EPMUNIFESP, EPMSciEL

Evaluation of extracorporeal circulation effects on gallstone formation

OBJECTIVE: The objective of the present study was to clarify the relationship between cardiopulmonary bypass with the use of a heart-lung machine and gallstones in a short-term follow-up. METHOD: A total of 135 patients with ischaemic heart disease were included in this study. All were followed up by the Cardiology Department of Hospital São Paulo, Federal University of São Paulo. They were divided into three groups: Group 1 - 51 patients who were treated clinically; Group 2 - 43 patients who underwent coronary artery grafting bypass without cardiopulmonary bypass; and Group 3 - 41 patients who underwent coronary artery grafting bypass with cardiopulmonary bypass and the use of a heart-lung machine. There were no statistically significant differences between the groups in relation to gender, age, body mass index or associated diseases (p<0.05). All the patients underwent ultrasound examination 12 months after beginning their cardiological treatment (clinical treatment alone or surgical plus follow-up). RESULTS: The prevalence of gallstones in the groups was: Group 1 - 7.84%, Group 2 - 11.62%, and Group 3 - 19.51%. There was no statistically significant differences between the groups (p = 0.248). CONCLUSION: It was concluded that cardiopulmonary bypass does not appear to have a close relationship with gallstone formation one year after coronary artery bypass grafting. However, long-term follow-up is advisable.OBJETIVO: Verificar a associação entre o uso da circulação extracorpórea e o desenvolvimento de colelitíase. MÉTODO: Foram estudados 135 pacientes coronariopatas acompanhados na Disciplina de Cardiologia da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina, no período de janeiro de 2000 a setembro de 2002, distribuídos em três grupos: Grupo 1 - 51 pacientes tratados clinicamente; Grupo 2 - 43 pacientes revascularizados sem circulação extracorpórea e Grupo 3 - 41 pacientes revascularizados com circulação extracorpórea. Foram controladas as variáveis sexo, idade, índice de massa corpórea e doenças associadas entre os grupos e foi realizada ultra-sonografia total de abdome em todos os pacientes, aos doze meses de tratamento (clínico ou cirúrgico), para verificar a existência de colelitíase. RESULTADOS: A prevalência de colelitíase encontrada nos grupos foi: Grupo 1 - 7,84 %; Grupo 2 - 11,62 % e Grupo 3 - 19,51 %. Não houve diferença estatisticamente significante entre os grupos quanto à existência de colelitíase (p=0,248). CONCLUSÃO: Baseado neste estudo não se pode afirmar que o uso da circulação extracorpórea predisponha a maior prevalência de colelitíase.UNIFESP-EPMUNIFESP-EPM Departamento de CirurgiaUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Disciplina de Cirurgia CardiovascularUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPM, Disciplina de Cirurgia CardiovascularSciEL

Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function

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