Coronary artery bypass graft: state of the art

A doença aterosclerótica cardiovascular é a maior causa de morte tanto no Brasil quanto nos países desenvolvidos, sendo, portanto, um assunto de relevância tanto para profissionais da área de saúde quanto para a população geral. Apresentamos, então, as formas de tratamento da doença, principalmente no enfoque cirúrgico, com a revascularização do miocárdio. Para tanto, iniciamos com um pequeno histórico que nos mostra como se chegou à operação como conhecemos hoje. Discutimos as técnicas atualmente empregadas neste tipo de operação e quando ela é feita com ou sem circulação extra-corpórea; quais são os pacientes com indicação para esse tipo de tratamento e o que se espera dos resultados, quais as perspectivas desse procedimento; e como a prática de cirurgias minimamente invasivas e a utilização da robótica auxiliam o cirurgião. Por fim, contextualizamos dois procedimentos novos: a revascularização percutânea, que ainda apresenta resultados incertos a longo prazoe a neoangiogênese, que é um procedimento em fase de estudo.The atherosclerotic cardiovascular disease is the greatest cause of death in Brazil as much as in the developed world. Therefore, it’s a relevant issue for health professionals and for general population. So, we present the treatments for the disease, focusing the surgery, with revascularization of the myocardium. Then, we start with a short report that shows how the operation achieves its actual state, the techniques currently applied in this kind of operation and when it’s done with or without extracorporeal circulation; who the patients for this treatment are and what results we can expect; the perspectives for this procedure, such as the practice of minimally invasive surgeries and the utilization of robotics to help the surgeon. At last, we contextualize two new procedures: the percutaneous revascularization, that still shows uncertain long-term results, and the neoangiogenesis, which still is in study phase

Spirometric Assessment of Lung Transplant Patients: One Year Follow-Up

OBJECTIVE: The purpose of this study was to compare spirometry data between patients who underwent single-lung or double-lung transplantation the first year after transplantation. INTRODUCTION: Lung transplantation, which was initially described as an experimental method in 1963, has become a therapeutic option for patients with advanced pulmonary diseases due to improvements in organ conservation, surgical technique, immunosuppressive therapy and treatment of post-operative infections. METHODS: We retrospectively reviewed the records of the 39 patients who received lung transplantation in our institution between August 2003 and August 2006. Twenty-nine patients survived one year post-transplantation, and all of them were followed. RESULTS: The increase in lung function in the double-lung transplant group was more substantial than that of the single-lung transplant group, exhibiting a statistical difference from the 1st month in both the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) in comparison to the pre-transplant values (p <0.05). Comparison between double-lung transplant and single lung-transplant groups of emphysema patients demonstrated a significant difference in lung function beginning in the 3rd month after transplantation. DISCUSSION: The analyses of the whole group of transplant recipients and the sub-group of emphysema patients suggest the superiority of bilateral transplant over the unilateral alternative. Although the pre-transplant values of lung function were worse in the double-lung group, this difference was no longer significant in the subsequent months after surgery. CONCLUSION: Although both groups demonstrated functional improvement after transplantation, there was a clear tendency to greater improvement in FVC and FEV1 in the bilateral transplant group. Among our subjects, double-lung transplantation improved lung function

A simple technique can reduce cardiopulmonary bypass use during lung transplantation

Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure