Early outcome after off-pump coronary artery bypass grafting: effect on mortality and stroke Resultado inicial após revascularização miocárdica: efeito na mortalidade e no acidente cerebrovascular

• Published in: Revista brasileira de cirurgia cardiovascular 2008-03, Vol.23 (1), p.23-28
• Main Authors: Delawer Reber, Marcus Fritz, Alfred Germing, Peter Marks, Axel Laczkovics
• Format: Article
• Language: English
• Subjects: Acidente cerebrovascular; Cerebrovascular accident; Coronary artery bypass; Myocardial revascularization; Ponte de artéria coronária; Revascularização miocárdica
• ISSN: 0102-7638; 1678-9741
• DOI: 10.1590/S0102-76382008000100005

OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated without cardiopulmonary bypass out of 1516 CABG procedures from January 2004 through May 2006. The mean age of the patient population was 70±11years, within a range of 27-88 years. Forty-eight (19%) patients were older than 80 years and there were 172 (69%) males. Mean graft per patient was 1.78±0.79. The internal mammary artery (IMA) graft was used in 95% of the patients. For eight (3.17%) patients this was the second procedure. RESULTS: Hospital mortality was 3.17%; Mean EuroSCORE in these patients was 10.36±6.67. No neurological complications occurred, six (2.38%) patients had temporary psycho syndrome. Postoperative myocardial infarction occurred in three (1.19%) patients. Two patients required rethoracotomy as a result of bleeding. Thirty-eight (15%) patients needed postoperative therapy for atrial fibrillation. CONCLUSION: CABG with OPCAB technique has the benefit of low mortality and morbidity in terms of stroke. The advantages of this technique depends on the patient's general condition at the time of the operation, the sufficiency of pump function and coronary morphology, as well as on the surgeon's experience.OBJETIVO: Uma das principais e devastadoras complicações da revascularização do miocárdio é o acidente cerebrovascular. Evitar a circulação extracorpórea (CEC) pode reduzir essa complicação neurológica. No passado, houve um interesse crescente na cirurgia de revascularização do miocárdio sem circulação extracorpórea. O benefício deste método de revascularização com relação ao acidente cerebrovascular e à mortalidade ainda é discutido de forma controversa. MÉTODOS: Uma análise retrospectiva dos dados coletados de 1.516 pacientes submetidos à cirurgia de revascularização do miocárdio, de janeiro de 2004 a maio de 2006, dos quais 252 pacientes que foram operados sem circulação extracorpórea. A média de idade da população da amostra foi de 70±11 anos, variando de 27 a 88 anos. Quarenta e oito pacientes (19%) tinham mais de 80 anos e 172 pacientes (69%) eram hom