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Patient Selection in Off-Cardiopulmonary Bypass
Revascularization
(#2002-03199 ... March 15, 2002)
Ricardo de Carvalho Lima, MD, MSc, PhD,1 Mozart Escobar, MD, MSc,2
José Glauco Lobo Filho, MD, MSc3
1Division of Cardiothoracic Surgery, Department of Surgery, Oswaldo Cruz University Hospital,
Faculty of Medical Sciences, Pernambuco State University, Recife, Pernambuco, Brazil.
2Member of Cardiothoracic Treatment Unit, Real Hospital Português, Recife, Pernambuco, Brazil.
3Surgeon of ICORP, Fortaleza, Ceará, Brazil.
ABSTRACT
Background: The last few years have been marked by
striking advances in off-pump coronary artery bypass grafting
(OPCABG), thanks mainly to developments in instrumentation
and technical progress in the revascularization of the
posterior arteries of the heart. In 2001, OPCABG was performed
on approximately 20% of patients who underwent
surgical myocardial revascularization in the United States.
This retrospective study aims to evaluate our experience with
this procedure over the past 10 years, emphasizing the rapid
and increasing progress of the method, indications, contraindications,
and results.
Methods: Between August 1991 and December 2001,
2,759 patients suffering from angina pectoris underwent
OPCABG. The patients' ages ranged from 13 to 93 years
with a mean of 63 years ± 12 years. The over 80-year-old
group accounted for 3.5% of the patients. Males represented
58% of the patients.
Results: Intraoperative mortality in OPCABG was low. In
the intraoperative period 0.4% of patients died, and the figure
for the postoperative period was 2.5%. It was noted that 7.9%
of the patients presented serious, nonfatal complications.
Conclusions: OPCABG is a reproducible procedure with
results similar to those obtained in revascularization of the
myocardium using extracorporeal circulation (ECC). We
believe that over 90% of patients can be operated upon without
the aid of extracorporeal circulation (ECC). In our experience,
all patients are potential candidates for myocardial
revascularization surgery without ECC.
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