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Search Results: 1 - 10 of 3033 matches for " myocardial revascularization "
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Cirurgia de revasculariza??o do miocárdio no idoso: estudo descritivo de 144 casos
DEININGER, Maurílio Onofre;OLIVEIRA, Orlando Gomes de;GUEDES, Marcelo Gentil Almeida;DEININGER, Eugênia Di Giuseppe;CAVALCANTI, Ant?nio Carlos Wanderley;CAVALCANTI, Maria das Gra?as Feitosa Wanderley;QUEIROGA, Ricardo Wanderley;LOPES, Norland de Souza;
Revista Brasileira de Cirurgia Cardiovascular , 1999, DOI: 10.1590/S0102-76381999000200004
Abstract: a retrospective analysis involving seventy-year-old patients as well as those over seventy who have undergone cabg as a single procedure, during jannuary 1992 to december 1997, was carried out with the purpose of assessing their morbidity with mortality. of the 144 patients, 92 (63.9%) were males, aged 70 to 84 (average age 73.51 and standard deviation 2.82). most of those, 114 (79.16%), suffered from angina belonging to the functional class iii or iv. the occurrence in the pre-operative period of obesity (p = 0.004), heart failure (iii/iv class - p = 0.03) and/or acute myocardial infection (less than 21 days - p = 0.01) demonstrated a definite relationship with mortality. there were 120 (83.34%) patients with lesions in three or more vessels (average 3.48 anastomoses/patients).the pediculate internal mammary artery was employed in 126 patients (87.5%) and that rate increased to 98.9% in the last two years. the main complications in the post-operation period leading to death were either infections (p < 0.0001), prolonged ventilatory support (p < 0.0001), renal failure with dialysis (p < 0.0001) and/or low cardiac output (p = 0.003). as to statistical analysis the student t test, the chi-square test and fisher's exact test were used. surgical mortality totalling 5.5% (8/144) in the first thirty post-operative days decreased to 1.53% (1/65) in the last two years. coronary artery bypass graft in the elderly can be a procedure with low morbidity and mortality if their body systems are carefully evaluated.
Revasculariza??o miocárdica em pacientes com idade igual ou superior a 70 anos
Souza, Januário M;Berlinck, Marcos F;Moreira, Myriam G;Martins, José Renato M;Moreira, Maria Cássia S;Oliveira, Paulo A. F;Senra, Dante F;Oliveira, Sérgio Almeida de;
Revista Brasileira de Cirurgia Cardiovascular , 1990, DOI: 10.1590/S0102-76381990000300002
Abstract: from january 1979 to october 1989, 7003 patients underwent myocardial revascularization and associated operations; there were 6511 patients under the age of 70, with early mortality of 2.5% (162/6511), in contrast to 492 patients 70 years of age or older with early mortality of 8,5% (42/492). among these 492 patients, 410 underwent isolated myocardial revascularization with early mortality of 5.1% (21/410); 54 patients underwent associated operatins (left ventricle aneurysmectomy in 30 patients, valvular operation in 21 patients and carotid endarterectomy in 3 patients) with early mortality of 14.8% (8/54) and 28 patients were operated on early after acute myocardial infarction and the early mortality was 46.4% (13/28). the differences among these death-rates were significant. a 96.1% follow-up was obtained up to 127 months. the elderly patients are at severe risk mainly when they undergo associated operations besides myocardial revascularization, and there is a more significant risk when they are operated on early after myocardial infarction.
Desfechos hospitalares em pacientes submetidos a interven??o coronária percutanea na vigência de síndromes coronárias agudas atendidos em Unidades de Pronto Atendimento (UPAs): resultados de um Centro de Cardiologia Terciário
Sant'Anna, Fernando Mendes;Alvarez, Fernando Suarez;Bruno, Ricardo Vasconcellos;Brito, Marcelo Bastos;Menezes, Sérgio;Correa Filho, Wilson Braz;Barrozo, Carlos Alberto Mussel;Silveira, Sérgio Luiz C?rtes da;
Revista Brasileira de Cardiologia Invasiva , 2010, DOI: 10.1590/S2179-83972010000100008
Abstract: background: emergency care units (ecus) were created to meet an urgent need of the brazilian government to improve health care to low-income population. ecus quickly became reference centers to treat chest pain in this population, due to their ability to provide prompt medical care, availability of last generation drugs and well trained staff. this study is aimed at describing the profile and inhospital follow-up of patients with acute coronary syndromes seen in these units and later referred to a tertiary hospital, where they were treated by percutaneous coronary intervention with stent implantation. method: three hundred patients were referred from ecus to santa helena hospital (cabo frio, rj) from july to december, 2009. one hundred and sixty four patients (202 lesions) were treated by percutaneous intervention with stent and were divided in two groups: group i included 86 patients with acute coronary syndromes with st segment elevation and group ii included 78 patients with acute coronary syndromes without st segment elevation. clinical and angiographic characteristics and in-hospital major adverse cardiac events were compared between the two groups. results: clinical and angiographic characteristics were similar in both groups except for smoking. angiographic success was obtained in 99% of the procedures. mean hospitalization time (ecu + tertiary hospital) was 6 days. there were 6 in-hospital major adverse cardiac events, 5 in group i and 1 in group ii (5.8% vs. 1.3%; p = 0.60). conclusion: late percutaneous revascularization of patients with acute coronary syndromes seen at ecus is a safe and effective procedure, with high success and low complication rates.
Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases
Fernandes, Paulo Manuel Pêgo;Jatene, Fabio Biscegli;Gentil, André Felix;Coelho, Fabrício Ferreira;Kwasnicka, Karina;Stolf, Noedir Antonio Groppo;Oliveira, Sérgio Almeida de;
Arquivos Brasileiros de Cardiologia , 2001, DOI: 10.1590/S0066-782X2001001000001
Abstract: objective: to test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. methods: in the control group (18 patients), surgery was performed with systemic hypothermia at 32oc and intermittent crossclamping of the aorta. extracorporeal circulation was used. in the preconditioning group (17 patients), 2 crossclampings of the aorta lasting 3min each were added prior to the intermittent crossclamping of the conventional technique with an interval of 2min of reperfusion between them. blood samples for analyses of ph, pco2, po2, sodium, potassium, calcium, and magnesium were obtained from the coronary sinus at the beginning of extracorporeal circulation (time 1), at the end of the first anastomosis (time 2), and at the end of extracorporeal circulation (time 3). results: no difference was observed in the results of the 2 groups, except for a variation in the ionic values in the different times of blood withdrawal; sodium values, however, remained stable. all patients had a good clinical outcome. conclusion: the results of intermittent crossclamping of the aorta with moderate hypothermia were not altered by the use of ischemic preconditioning.
Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases
Fernandes Paulo Manuel Pêgo,Jatene Fabio Biscegli,Gentil André Felix,Coelho Fabrício Ferreira
Arquivos Brasileiros de Cardiologia , 2001,
Abstract: OBJECTIVE: To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. METHODS: In the control group (18 patients), surgery was performed with systemic hypothermia at 32oC and intermittent crossclamping of the aorta. Extracorporeal circulation was used. In the preconditioning group (17 patients), 2 crossclampings of the aorta lasting 3min each were added prior to the intermittent crossclamping of the conventional technique with an interval of 2min of reperfusion between them. Blood samples for analyses of pH, pCO2, pO2, sodium, potassium, calcium, and magnesium were obtained from the coronary sinus at the beginning of extracorporeal circulation (time 1), at the end of the first anastomosis (time 2), and at the end of extracorporeal circulation (time 3). RESULTS: No difference was observed in the results of the 2 groups, except for a variation in the ionic values in the different times of blood withdrawal; sodium values, however, remained stable. All patients had a good clinical outcome. CONCLUSION: The results of intermittent crossclamping of the aorta with moderate hypothermia were not altered by the use of ischemic preconditioning.
Modifica??es evolutivas da necessidade de cirurgia de revasculariza??o miocárdica de emergência em indivíduos submetidos a interven??o coronária percutanea: análise de 9.938 pacientes
Campos, Carlos Augusto Homem de Magalh?es;Yugar, Mila;Petrizzo, Antonia;Ribeiro, Expedito E.;Ribeiro, Henrique;Spadaro, Andre G.;Perin, Marco;Lemos, Pedro A.;Martinez, Eulogio;Marchiori, Gilberto;Ramires, José Antonio F.;
Revista Brasileira de Cardiologia Invasiva , 2010, DOI: 10.1590/S2179-83972010000200011
Abstract: background: percutaneous coronary interventions (pci) in centers without cardiac surgery represent a real option in the current context of interventional cardiology. the purpose of this study was to evaluate changes in the incidence and indications for coronary artery bypass grafting in patients undergoing pci from 1992 to 2005 method: data from 9,938 patients undergoing pci in two centers were divided into three groups: pre-stent period, from 1992 to 1996 (n = 2,500), intermediate period, from 2002 to 2003 (n = 3,711) and more recent period, from 2004 to 2005 (n = 3,727) results: since the advent of stents, an older population (58.2 ± 10.7 years vs. 62.7 ± 11.7 years vs. 67.8 + 11.6 years; p = 0.01), with more complex type b2/c lesions (52.2% vs. 72.7% vs 79%; p < 0.01) is being treated, with a lower rate of acute vessel occlusion (7.8% vs. 1.7% vs. 1.1%; p < 0.01), emergency coronary artery bypass grafting (1.2% vs. 1,1% vs. 0.7%; p < 0.01) and mortality (3.3% vs. 2.2% vs. 2%; p < 0.01). predictors of the need of emergency bypass surgery were multivessel disease [odds ratio (or) 3.42, 95% confidence interval (95% ci) 1.75-6.7), acute myocardial infarction (or 3.65, 95% ci 2.3-5.8) and lesion complexity [type b2/c, american heart association/american college of cardiology - aha/acc (or 3.27, 95% ci 1.6-6.75)]. the use of stents, however, conferred a protective effect against the need of emergency bypass surgery (or 0.58, 95% ci 0.4-0.85) conclusion: advances in technology, devices and adjunctive pharmacotherapy have improved pci, reducing the need of emergency coronary artery bypass grafting.
Comprometimento do plexo braquial na cirurgia cardíaca para revasculariza??o do miocárdio por esternotomia mediana: avalia??o clínica
ATRA, MAURO;GABBAI, ALBERTO ALAIN;
Arquivos de Neuro-Psiquiatria , 1999, DOI: 10.1590/S0004-282X1999000600013
Abstract: to evaluate the involvement of brachial plexus in cardiac surgery with median sternotomy for the revascularization of the myocardium 113 patients (87 men and 26 women) were clinically examined in the pre-operative and between the fifth and eighth post-operative days. the internal thoracic artery was used in 65 of the 113 patients. the electroneuromyography was not effected in any of the patients. a lesion of the brachial plexus was found in three patients though the internal thoracic artery was used in only one patient.we believe that factors such as posture of the patient, hypothermia, thoracic braces and use of the internal thoracic artery are relevant in the lesions. hence one must be attentive to all the factors mentioned above so as to avoid or minimize the lesions.
Revasculariza??o direta do miocárdio com as duas artérias mamárias internas: análise de 442 casos
Jatene, Marcelo B;Puig, Luiz Boro;Jatene, Fábio B;Ramires, Ant?nio F;Oliveira, Sérgio de Almeida;Dallan, Luís Alberto;Fontes, Ronaldo D;Jatene, Adib D;
Revista Brasileira de Cirurgia Cardiovascular , 1990, DOI: 10.1590/S0102-76381990000200002
Abstract: from june 1984 to november 1989, 4958 patients (pts) were submitted to myocardial revascularization in the heart institute, and in 54% at least one internal mammary artery was used. in 442 (8,9%) pts both intenal mammary arteries, right (rima) and left (lima) were used, isolated or associated to ther grafts. the age ranged from 30 to 78 years old (52,7y) and 399 were male. the pts were separated in 4 groups, being: g i 232 (52,4%) pts - lima to left anterior descending artery (lad) and rima to lad branches or circumflex (cx) branches in retroaortic position; g ii 135 (30,5%) pts - lima to lad and rima to right coronary artery (rca); g iii 48 (10,8%) pts - lima to cx branches and rima to lad as a free graft; g iv 27 (6,1%) pts - different associations with both arteries. the lima was used in situ in 440 pts and as free graft in 2; the rima was used in situ in 379 pts and as free graft in 63; the average number of grafts/pts was 3,17, considering the association with saphenous vein and other grafts. respiratory insufficiency and low cardiac output syndrome were the main complications in 37 (8,3%) and 23 (5,2%) pts, respectively; 16 (3,6%) pts had post operatory myocardial infarction and 15 (3,3%) had wound closure complications. the mortality rate was 4,91% (22 pts) and the main causes of deaths were multiple system organ failure in 7 (31,8%) and myocardial insufficiency in 6 (27,3%). the mortality rate was higher in pts with severe myocardial dysfunction and older than 60 years old and the best graft patency was observed when the lima was anastomosed to the lad (93,8%). the use of both intenal mammary arteries showed good results and acceptable morbidity and mortality.
Angioplastia cirúrgica de óstio e tronco coronariano: experiência de oito casos
Loures, Danton R. R;Ribeiro, Edison J;Almeida, Rui Sequeira de;Ferreira, Maria Jo?o A;Bueno, Ronaldo R. L;Andrade, Paulo Mauricio P;Pereira, Marcos Augusto A;Rossi, Paulo Roberto F;
Revista Brasileira de Cirurgia Cardiovascular , 1990, DOI: 10.1590/S0102-76381990000300004
Abstract: between april 1980 and march 1990 we performed eight surgical angioplasties of the left main coronary artery and/or its ostium and of the right coronary artery's ostium. there was no early mortality, and these patients were followed by a period of one to 109 months (medium of 43.2 months). we have observed improvement in the clinical symptoms and functional class. a new angiocardiography was performed in six patients, for angioplasty control and left ventricular (l v) function evaluation if there was an adequate anatomy on the surgical corrected site and an improvement on the l v contractility and ejection fraction. there were two late deaths. one patient died 39 of postoperative months in congestive heart failure and with angor pectoris, the other one in a car accident 109 months after the surgical correction. these results lead us to conclude that surgical angioplasty for ostium, right or left main coronary artery due to obstructive lesions, isolated or associated with other defects, is an optimal procedure to coronary revascularization.
O espectro da reopera??o em cirurgia de coronária
Dinkhuysen, Jarbas J;Souza, Luiz Carlos Bento de;Anijar, Alberto M;Paulista, Paulo P;Chaccur, Paulo;Piegas, Leopoldo S;Manrique, Ricardo;Arnoni, Antoninho S;Sousa, J. Eduardo M. R;Jatene, Adib D;
Revista Brasileira de Cirurgia Cardiovascular , 1989, DOI: 10.1590/S0102-76381989000100004
Abstract: the authors present the results obtained in the first 30 day p.o. of 204 patients who underwent reoperations for coronary atherosclerosis. the interval between first and second operation varied from 1 month to 16.5 years. there was also two small groups of patients of third intervention and with associated cardiac lesions. the basic strategy consisted on anticoagulation, the aplication of the mammary arteries (one or two) whenever possible, and revascularization as complete as possible. most patients showed uneventfull evolution and a quarter of them presented some kind of non-fatal complication with good response to specific therapeutic measures. the overall mortality was about 9%. patients with atherosclerotic lesions in native coronary circulation presented the greater morbidity, but in those with atherosclerotic lesions both in the grafts and coronary native circulation, the mortality was higher. contrary to expectation, the younger group showed higher mortality, and the older group presented higher morbidity. the aplication of the ima's on the reintervention does not add morbidity or mortality, but the concomitant correction of the associated cardiac pathologies represented a higher risk in the procedure. recent myocardial infarction influenced also morbidity. the third intervention, failure transluminal angioplastic coronary dilatation and the presence of previous ima does not exert deleterious impact on the morbidity or mortality.
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