Estrategia para reducir el riesgo operatorio en las reintervenciones de las arterias coronarias. Abordajes. Técnicas. Medidas preventivas

Abstract

BackgroundCoronary re-operations are always a challenge for the surgical team. Most of the time, the only patent graft is the left internal thoracic artery to the left anterior descending coronary artery, and is the one keeping the patient alive. In this condition, the re-sternotomy can lead to a catastrophic event. For this reason, many alternative approaches have been suggested to decrease the operative risk and improve results. We believe that not only the surgical approach but a series of measures that will create the special strategy, which is required for these patients who are usually elderly, and will have comorbidities which have the potential to compromise both the operation and the recovery. MethodsWe present our experience, from 2003 until 2015, of 95 patients who had coronary reoperations in our centre avoiding resternotomy, all of them through a left thoracotomy, right thoracotomy, or sub-xiphoid approach, the use of prophylactic intra-aortic balloon pump, cell saver, off pump surgery, avoiding manipulation of the aorta, and minimising the manipulation of the heart. ResultsThe surgical mortality rate was only 1.05%, and allowing a fast recovery and early discharge of the majority of the patients, despite the aforementioned risk factors.