Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295). CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome

Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295). CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome

Tratamento cirúrgico de mixoma do coração duplamente recidivado, em paciente testemunha de Jeová: relato de caso

A recidiva de mixoma cardíaco após sua remoção cirúrgica é incomum. Isso se deve à excisão de sua base de implantação nas paredes do coração. Caso essa ressecção não seja ampla, existe a possibilidade da recidiva do tumor. Os autores descrevem o caso de paciente do sexo masculino, 26 anos de idade, com antecedentes de recidiva de mixoma de átrio esquerdo em duas ocasiões e ressecção com sucesso. O paciente foi admitido em nosso Serviço devido à presença de tumor em átrio esquerdo. O exame ecocardiográfico revelou massa pediculada, localizada no septo interatrial. Por tratar-se de testemunha de Jeová, não recebeu sangue ou hemoderivados durante todo o tratamento cirúrgico. Na operação observou-se massa gelatinosa fixada no septo interatrial. Foi realizada ampla ressecção do tumor e de sua inserção no septo. O exame histopatológico constatou tratar-se de mixoma cardíaco.<br>Recurrence of cardiac myxoma after excision is uncommon. The complete excision of the base of the tumor from the heart wall prevents its recurrence. In cases without wide resections , the probability of tumor recurrence rises. The authors report the case of a 26 year old male patient with recurrent left atrium myxoma presenting on two occasions. The patient was admitted with a left atrium tumor. Echocardiogram disclosed a tumor in interatrial septum. The patient is a Jehova's witness and did not receive whole blood or any blood products during the hospital stay. At operation a gelatinous mass fixed on interatrial septum was found. A wide resection was done, including the septal insertion of the tumor. Pathological examination revealed it to be a cardiac myxoma