Abstract
Between July 1958 and April 14, 1963, a group of 1,000 patients underwent cardiac surgery with extracorporeal circulation, being 680 patients in the Hospital das Clinicas of the Faculty of Medicine, University of Sao Paulo and 320 patients in the Institute of Cardiology of the State of Sao Paulo. In this group are not included aortic aneurysms operated with partial perfusion without the use of the oxygenator. Perfusions were performed through a set of artificial heart-lung machine consisting of occlusive pump and disks oxygenator type Kay-Cross. The overall mortality in this series was 11.3%, having declined 25% in the first hundred cases to 7% in the last hundred. In the first patients, we observed mortality directly related to the perfusion process, with prolonged anoxic cardiac arrest, observing several cases of complete atrioventricular block. These complications disappeared gradually and mortality came to have a direct relationship with the severity of the condition being corrected. When we started the corrections of tetralogy of Fallot and complex mitral lesions, the mortality rate rose again. With experience, there were fewer complications in these cases. In the four following tables are exposed the main cardiopathies undergoing correction, using cardiopulmonary bypass. Symposium held during the XIX Brazilian Congress of Cardiology in Salvador, Bahia, on 07/18/1963. 1. In the first group (table 1) are exposed 274 acyanotic congenital heart diseases with arteriovenous flow; mortality was 6.9%. Among interauricular communications, only at the beginning of our experience we lost two cases (1.4%), being 1 in the group of 112 simple lesions and 1 in the group of 24 lesions associated with anomalous pulmonary veins. Among 26 patients with atrioventricularis communis the mortality rate was 15.3%, being higher in the overall shape of the deformity, when there is an associated VSD. In the partial order, with cleft of the mitral or tricuspid valve, one patient died among 19 patients operated. In a group of 102 VSD, we observed 12.7% mortality, with 24.4% in the 45 cases with high pulmonary hypertension and only l, 8% in the group of 55 cases with mild pulmonary hypertension. In two cases of ventricular septal defect associated with congenital mitral lesions there was one death. In this group are also three cases of communication between the left ventricle and the right atrium, 2 cases of communication between the aorta and the right ventricle, 1 case of anomalous drain of the right pulmonary veins without interatrial communication, a case of single ventricle, 2 cases of interatrial and interventricular communications associated and one case of aortic-pulmonary fistula. EXPERIENCE IN CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS: STUDY OF A SERIES OF 1000 OPERATED CASES Symposium
Highlights
Between July 1958 and April 14, 1963, a group of 1,000 patients underwent cardiac surgery with extracorporeal circulation, being 680 patients in the Hospital das Clinicas of the Faculty of Medicine, University of São Paulo and patients in the Institute of Cardiology of the State of
In this group are not included aortic aneurysms operated with partial perfusion without the use of the oxygenator
Eight cases of mitral valve lesions associated with ventricular septal defect (VSD) were operated with cardiopulmonary bypass
Summary
Facing a congenital heart disease it will not be amenable to surgery only in two circumstances: 1) when there is still not a surgical technique that may benefit the patient: in this case are the holders of common arterial trunk, single ventricle with large pulmonary circulation and aortic atresia; 2) when the evolution or the stage reached by the disease no longer allows surgical treatment: in this group are included heart diseases with abnormal communication between the arterial and venous sector (at auricular, ventricular or pulmonary levels), with large pulmonary hypertension and pure or predominant venoarterial shunt. Among the complications of lesser consequence should be highlighted: a) total temporary atrioventricular block, occurring in 5 cases, b) signs of heart failure, of major or minor degree, in 8 patients, 2 of which it was confirmed persistent left-right shunt (both reoperated with good results in one case), in other cases, heart failure could be controlled clinically, c) postoperative bleeding, with reopening of the chest in two patients, d) acute renal failure in one case, with full recovery after the use of artificial kidney; e) signs of transient cerebral anoxia due to inadequate perfusion in all three cases recovered and normal f) the serious pulmonary complications, in the beginning of our experience with cardiopulmonary bypass stopped since the systematic use of continuous decompression of the left cardiac cavities during cardiopulmonary bypass.
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