Revascularização miocárdica em pacientes octogenários: estudo retrospectivo e comparativo entre pacientes operados com e sem circulação extracorpórea Myocardial revascularization in octogenarian patients: retrospective and comparative study between patients operated on pump and off pump

Abstract

OBJETIVO: O objetivo do presente trabalho é comparar e analisar os benefícios da cirurgia com e sem CEC, em pacientes octogenários. MÉTODO: Foram analisados dados retrospectivos dos pacientes com 80 anos de idade ou mais, no período de dezembro 1995 a dezembro de 2003. Neste período, 73 pacientes foram submetidos à revascularização do miocárdio (RM), sendo 26 (35,6%) com CEC e 47 (64,4%), sem CEC. Os dados demográficos, fatores de risco pré-operatório, comorbidades, classe da angina (CCVS), complicações pós-operatórias e resultados cirúrgicos foram comparados entre os dois grupos (com CEC e sem CEC). Utilizou-se o teste de "t de Student" na comparação entre os grupos e foi considerado um nível de significância de p OBJECTIVE: The purpose of the present study is to compare and analyze the benefits of this operation with and without cardiopulmonary bypass in octogenarian patients. METHOD: Retrospective data of the patients aged eighty years or more from December 1995 to December 2003 were analyzed. During this period 73 patients were submitted to coronary artery bypass grafting (CABG), 26 (35.6%) on-pump and 47 (64.4%) off-pump. A comparison was made of the demographic data, preoperative risks, concurrent morbid conditions, types of angina, postoperative complications and surgical outcomes between the on-pump and off-pump groups. The Student t-test was used to compare the groups and the level of significance was set at p-value < 0.05. RESULTS: Both groups showed a high preoperative risk, although the off-pump group presented less surgical mortality (11.5% vs 2.1%, p < 0.05). No strokes were observed in the patients operated on off-pump (11.5% vs 0.0%, p < 0.005). Atrial fibrillation (AF) in the immediate postoperative period was present less often in the off-pump group (30.8% vs 12.8%, p < 0.005). The postoperative mechanical ventilation time and the presence of respiratory failure were less in the off-pump group (p < 0.005). The presence of acute renal insufficiency (ARI) was 19.2% in the on-pump group and 0% in the off-pump group (p < 0.05). There was less need for transfusion of blood or blood derivatives in the off-pump group (69.2% vs 31.9%, p < 0.005). The mean sojourn in the intensive care unit (ICU) was shorter in the off-pump group (p < 0.05). The percentage of patients with no postoperative complications was higher in the off-pump group than in the on-pump group (89.4% vs 61.5%, p <0.001). CONCLUSIONS: The present study suggests that patients aged eighty years and over benefit when submitted to off-pump CABG and that this procedure is associated with low rates of postoperative complications such as stroke, AF, ARI and respiratory insufficiency, and with less time in the ICU, a shorter hospital sojourn, less use of blood derivatives and lower mortality. In octogenarian patients off-pump CABG surgery is a safe and effective technique, and may be the operation of choice when correctly indicated.

Keywords

• Revascularização miocárdica
• Circulação Extracorpórea
• Myocardial revascularization
• Extracorporeal circulation