Revascularização cirúrgica do miocárdio em pacientes com stents coronários Coronary artery bypass grafts in patients with coronary stents

Abstract

OBJETIVO: Analisar as características cirúrgicas de pacientes operados após a intervenção coronária percutânea (ICP). MÉTODO: Cinqüenta e seis pacientes (41 H e 15 M), no momento da revascularização cirúrgica do miocárdio, já tinham sido manejados com o implante de stents coronarianos. Foram implantados 116 stents em 101 intervenções. Trinta e dois pacientes tinham três ou mais vasos com estenose significativa. Seis pacientes com lesões graves no tronco da artéria coronária esquerda (TCE) foram tratados com stents. Desde a colocação do primeiro stent, 12 pacientes desenvolveram lesões de novo graves no TCE. Em seis (50%), a estenose grave se desenvolveu em até seis meses da colocação do stent. Vinte (35,7%) pacientes eram diabéticos. Em 22 (39,2%) doentes, no momento da cirurgia, havia diminuição significativa da fração de ejeção do VE (pOBJECTIVE: To observe the surgical characteristics of patients operated on after percutaneous coronary intervention (PCI). METHOD: Fifty-six patients (41 M and 15 F), by the time of coronary artery by-pass grafts (CABG), already had undergone coronary stenting procedures. In 101 PCI, 116 stents were implanted. By the time of the first PCI, 32 patients had three or more coronaries with severe stenosis. Six patients were treated with PCI for severe left main stem stenosis. Since the implantation of the first stent, 12 patients developed severe de novo lesions in the left coronary trunk. In six of these, the stenosis was developed in 6 months after the implant of the stent. Diabetes was present in 35.7% of the patients. In 22 patients (39.2%), at the time of CABG, the left ventricular (LV) function was reduced (p<0.001). At surgery, 160 grafts were implanted. Surgical studies included coronary and muscle biopsy. RESULTS: Surgical observation showed arteritis and inflammatory tissues adjacent to the stent in comparison to other areas. Seventeen patients that could not have antiplatelets drugs withdrawn needed more blood transfusion. There were no hospital deaths. CONCLUSION: In patients operated on after stents implantation, facts like loss in LV function or de novo vascular lesions add complexity to surgical cases and may impair long-term results. Due to endothelial dysfunction caused by stents, grafts may close earlier. In addition, the efficiency of clinical therapy may not be the same.

Keywords

• Contenedores
• Revascularização miocárdica
• Arteriosclerose Coronária
• Stents
• Myocardial revascularization
• Coronary arteriosclerosis