Search

ObjectivesClinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent.DesignRetrospective case-control studySettingsMajor academic tertiary referral medical centerParticipants274 consecutive patients who underwent open heart surgery with cardiopulmonary bypass 2009 - 2013.InterventionsThe outcomes of 86 patients who received pulmonary perfusion and ventilation during cardiopulmonary bypass were retrospectively compared to the control group of 188 patients.Measurements and Main ResultsRespiratory complications rates were similar in both groups (33.7% vs. 33.5%), as were the rates of postoperative pneumonia (4.7% vs. 4.3%), pleural effusions (13.9% vs. 12.2%) and re-intubations (9.3% vs. 9.1%). Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3% vs. 8.5%) and atrial fibrillation (33.7% vs. 28.2%) were equivalent in both groups. Incidence of sepsis (8.1% vs. 5.3%), postoperative stroke (2.3% vs. 2.1%), acute kidney injury (2.3% vs. 3.7%) and renal failure (5.8% vs. 3.7%) were likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8% vs. 5.3%, p=0.031) and the need for mediastinal re-exploration (17.4% vs. 9.6%, p=0.0633) were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. ICU and hospital stays, and the ICU readmission rates (7.0% vs. 8.0%) were similar in both groups.ConclusionsSimultaneous pulmonary perfusion and ventilation during cardiopulmonary bypass were not associated with improved clinical outcomes.

INTRODUÇÃO: A cirurgia cardíaca com o coração batendo está sendo cada vez mais utilizada para minimizar danos cerebrais, renais e outros. Porém, a incidência de infarto nos períodos per e pós-operatório e seu efeito a longo prazo, especialmente quando esta técnica é comparada às tradicionais, ainda não foi totalmente esclarecida. CASUÍSTICA E MÉTODOS: Um estudo retrospectivo de 303 pacientes (122 sem CEC, 181 com CEC) foi realizado de fevereiro/97 a fevereiro/99. Dosagens de CK-MB e eletrocardiogramas foram avaliados nos períodos per e pós-operatório, troponina T (TnT) foi medida no período pós-operatório. Os dois grupos foram comparáveis quanto a idade (65 ± 10 anos vs. 65 ± 9 anos), classificações CCS e NYHA. RESULTADOS: O número médio de enxertos com CEC foi de 3,10 vs. 2,26 sem CE. Infarto peri-operatório, assim como morbidade e mortalidade (7/181 vs. 6/122) foram comparáveis. Apesar de mais elevados no grupo com CEC, os níveis pós-operatórios de CK-MB e troponina T não atingiram diferença estatística, tendo sido observados 21 infartos agudos por critérios bioquímicos que se distribuíram igualmente entre os grupos. Uma correlação inversa entre o número de enxertos e a liberação de troponina foi observada na fase inicial da nossa experiência sem CEC. Não houve relação entre a localização do enxerto e a incidência de infarto ou liberação de troponina. CONCLUSÃO: A proteção miocárdica, morbidade e mortalidade obtidas com as duas técnicas de revascularização estudadas foram semelhantes. Considerando os efeitos adversos da CEC, já documentados na literatura, particularmente sobre os sistemas neurológico, respiratório e renal sugerimos esta técnica como uma alternativa segura para a revascularização miocárdica.BACKGROUND: CABG surgery on the beating heart (off-pump) is increasingly used to lessen injury to the brain, kidneys and other organs. However, the perioperative incidence of myocardial injury and its effect on outcome vs conventional CABG (on-pump) remains unclear. MATERIAL AND METHODS: Retrospective study of 303 patients (122 off-pump, 181 on-pump) after isolated CABG from Feb/97-Feb/99. CPK and EKG were obtained pre and post-op, MB fraction and troponin T levels were measured postoperatively. Complications were also recorded. The groups were comparable in terms of age (65 ± 10 vs 65 ± 9 yr), CCS and NYHA class. RESULTS: Mean number of grafts was 3.10 on-pump vs 2.26 off-pump. Perioperative myocardial infarction, morbidity and mortality (7/181 vs 6/122) were also comparable. There were higher postoperative CK levels in the on-pump group compared to the off-pump (548 ± 420 vs 236 ± 365). MB fraction was slightly higher in the on-pump group, but not significantly different (62 ± 197 vs 29 ± 46) nor was troponin T levels (3.5 ± 16 vs 3.5 ± 17) were An inverse correlation between the number of grafts and troponin T release in the off-pump group occurred early during our off-pump experience. There was no correlation between graft location and the incidence of infarcts or troponin T release. CONCLUSION: The higher troponin T release during our initial experience subsequently decreased. This suggests that improvements in operative technique (e.g. better exposure allowing more posterior grafts without surface trauma) may be responsible. Current techniques make off-pump CABG a safe alternative for revascularization.