Revascularization Coronary Artery Bypass Grafting Research Articles

Complete surgical myocardial revascularization in patients with declined renal functions: 12-month outcomes

IntroductionThis retrospective observational study aimed to evaluate the feasibility and effectiveness of complete revascularization coronary artery bypass grafting (CABG) in patients with multi-vessel disease (MVD)-CAD and declined renal functions, addressing the knowledge gap regarding optimal treatment strategies and outcomes in this specific patient population.MethodsBetween 2020 and 2022, a total of 58 patients underwent on-pump coronary artery bypass grafting surgery for complete myocardial revascularization in this study. To assess overall survival, Kaplan–Meier with the log-rank test was conducted for statistical analysis.ResultsThe mean age of cohort was 60.7. The findings showed a high prevalence of medical conditions such as hypertension (50.0%), diabetes (50.0%), and anaemia (41.4%) among the participants. Intraoperatively, low cardiac output syndrome was reported in 5.2% of cases, while perioperative outcomes indicated a need for transfusions in 53.5% of cases and an in-hospital mortality rate of 3.4%. At the 12-month follow-up, no redo revascularization or renal replacement therapy was required, but cardiac mortality was 5.2% and all-cause mortality was 6.9%.ConclusionsThe study concluded that complete revascularization is safe for these patients and highlights the potential benefits, emphasizing the need for further research in optimizing revascularization techniques for this population.

Abstract 11532: Cardiac Complications in Polyarteritis Nodosa: A Case of Multi-Vessel Coronary Occlusion Treated With 4-Vessel Coronary Artery Bypass Grafting

Polyarteritis nodosa (PAN) is a necrotizing vasculitis causing intimal proliferation, luminal narrowing, thrombosis, ischemia, and even infarction. Coronary manifestations are rare, though recent evidence suggests coronary disease may progress rapidly causing significant morbidity and mortality. We report a case of multi-vessel occlusive coronary artery disease (CAD) in a patient with systemic PAN, successfully managed with 4-vessel coronary artery bypass grafting (CABG). An obese 53-year-old male with hypertension, hyperlipidemia, and tobacco use presented with episodic epigastric pain. Serial troponins and EKGs did not suggest cardiac ischemia. Cardiac MRI showed concentric LV hypertrophy with preserved systolic function without signs of infiltrative disease or fibrosis. Abdominal CT demonstrated splenic infarction, luminal narrowing of the celiac axis, and abdominal aortic and bilateral iliac artery aneurysms. MRA revealed inflammation of the celiac, splenic, and common hepatic arteries. CT angiography revealed beading of the superior mesenteric artery and celiac trunk, indicative of vasculitis. C3 and C4 levels were elevated. Polyarteritis nodosa was felt to be his unifying diagnosis. Prior to initiating cyclophosphamide, he returned with severe epigastric pain prompting admission. Endoscopy was negative. Coronary CT showed extensive calcification. Angiography revealed multi-vessel occlusive disease patterned with ectasia. He underwent 4-vessel CABG revascularization with LIMA-LAD and SVG-OM-LPDA-RPDA. After surgery, he began prednisone, dual anti-platelet, statin, beta-blocker, and angiotensin receptor blockade with rheumatology follow-up for optimal timing of cyclophosphamide initiation. For patients with systemic inflammatory conditions, recognition of atypical anginal events is crucial as typical identifiers of atherosclerosis may not be obvious. Bypass is definitive therapy, as stenting arteritic vessels may result in neo-endothelization. Clinicians must recognize increased risk of CAD while offering appropriate primary and secondary interventions such as screening imaging and knowledge of disease distribution for appropriate graft choice.

Benefits of delayed revascularization following ligation of anterior descending artery after a stab wound

Penetrating cardiac trauma often results in death. However, in rare cases when patients survive, there is almost always a need for damage control by artery ligation. Following that, revascularization is recommended as soon as possible. The extent to which revascularization is effective has not yet been studied and agreed upon. A 24-year-old man with a penetrating stab wound to the heart and left anterior descending (LAD) artery received primary life-saving treatment with artery ligation and was then referred for revascularization. Nonetheless, the patient did not consent to coronary artery bypass grafting (CABG) and was discharged against medical advice with ejection fraction (EF) of 20%. He returned three months later due to chest pain and heart failure, then underwent revascularization which increased the patient’s EF to 45% and significantly improved the symptoms. Although CABG revascularization is recommended as soon as possible after main coronary arteries are ligated, our patient showed that such patients benefit from delayed revascularization surgery and that they should not be deprived of its benefits only because of the long time passed.

EuroSCORE II Validation as a Method for Cardiac Surgery Risk Stratification in Mexico

Objective: To Validate the EuroSCORE II as a method for cardiac surgery risk stratification in Mexican adult population. Methods: We included adult patients undergoing to cardiac surgery, in order to determine the predictive value of EuroSCORE II on morbidity and mortality risk. Continuous variables are presented as mean ± SD or median with its interquartile range as appropriate; categorical variables were described as n, % or rate. To validate the EuroSCORE II scale, the assessment was done with Hosmer- Lemeshow (HL) test. In terms of discrimination, we used the features of the receiver operation characteristic (ROC) curves. Results: They were 704 patients, grouped into five categories: simple (one vessel) Coronary Artery Bypass Grafting (CABG) surgery, n= 299 (43%) cases. CABG revascularization (two or more vessels), n= 208 (30%). Double Procedure (CABG + valve replacement) 174 (25%) cases. Triple procedure (CABG + valve + aorta surgery) 23 (3.3%) patients. The mortality observed within 30 days of the surgery was 88 (12.5%). Meanwhile, the mean of the expected mortality predicted by EuroSCORE II was 3.63 ± 5.91 (95% CI: 3.19-4.06). The EuroSCORE II scale presented a good capacity for discrimination in the studied population reaching an area under the ROC curve of 0.821 (p < 0.000, 95% CI: 0.772-0.871). A calibration for the scale measured through logistic regression with goodness of adjustment of Hosmer-Lemeshow was determined (χ2 = 17.74, p = 0.64). Conclusion: EuroSCORE II showed moderate discrimination ability in general. The scale can be useful to identify some problems in our hospital, however, the mortality rate might be underestimated. Key words: Euroscore II; Adult Cardiac Surgery; Surgical Risk

Hybrid and Robotic-Assisted Coronary Artery Revascularization Compared to Conventional Coronary Artery Bypass Graft Revascularization

Hybrid and Robotic-Assisted Coronary Artery Revascularization Compared to Conventional Coronary Artery Bypass Graft Revascularization

Redo Coronary Artery Bypass Grafting: On-Pump and Off-Pump Coronary Artery Bypass Grafting Revascularization Techniques

To analyze the short-term outcomes of redo coronary artery bypass grafting (CABG) using on-pump and off-pump CABG techniques. From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique (redo-ONCAB group) and 40 underwent off-pump CABG technique (redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc. There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group (all P>0.05), except for incidences of renal dysfunction and pulmonary disease (all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups (P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time (P=0.0045), postoperative ventilation (P=0.0211) and intensive care unit stay (P=0.0400), as well as fewer use of platelet (P=0.0338) and blood transfusion (P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization (P=0.0253) and the use of transmyocardial laser revascularization (P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group (all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups (all P>0.05). Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.

Use of Endothelial Progenitor Capture Cell Stent During Percutaneous Treatment of Coronary Bifurcations

The treatment of bifurcation lesions remains a challenge with poor immediate results and higher restenosis rate than in nonbifurcated lesions. Drug-eluting stents improve the outcome after coronary stenting, but are associated with a small but statistically significant increase in late and very late stent thrombosis. Thus, aim of the present study was to evaluate the angiographic and clinical results of a new type of stent (coated with murine monoclonal antihuman CD34 antibodies designed to attract circulating endothelial progenitor cells to rapidly establish a functional endothelial layer and promote healing stent implantation) in a cohort of consecutive patients with coronary bifurcation lesions. Between December 2007 and July 2008, a total of 43 consecutive patients were enrolled and 47 consecutive bifurcation lesions were treated with endothelial progenitor capture cell stents. The angiographic end points binary restenosis rate inside the stent (within 5 mm of the stent edges or in the segments treated with balloon angioplasty) was 5% (2.1% in the main branch and 10.5% in the side branch). No stent thrombosis was observed. Clinical follow-up was completed in all patients at mean time of 34.5 days after percutaneous coronary interventions by clinical evaluation and 12.3 months with a telephone contact. Angina at rest was present in 3 patients (7.9%). No in-hospital, 30-days, or 12-months major adverse cardiac events (death, myocardial infarction, and repeat revascularization coronary artery bypass graft or percutaneous coronary angioplasty) were reported. The use of endothelial progenitor capture cell in the setting of coronary bifurcation appears to be feasible and safe with no incidence of late stent thrombosis and a very low rate of repeated revascularization.

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

With the increased global burden of an aging population manifesting cardiovascular disease, the decision process for use of coronary revascularization options in older adults has gained attention. Assessment of physiologic status has greater bearing than chronologic age; items that have proven of particular merit in evaluating comorbidities as they relate to treatment prognosis for both PCI and CABG in older adults include EuroSCORE and frailty scoring. Evaluation of neurocognitive function can uncover the presence and severity of all-cause dementia, which may be missed in simple medical history interaction. These data have significance when considering aggressive coronary artery disease treatments in this population for symptomatic and/or survival benefit, particularly when high priority is placed on quality of life and independent living post-treatment. Recovery after procedural intervention is slower and with increased morbidity in older adults. Older adults tend to have more complex coronary artery disease; for some, the risk/benefit of revascularization may be prohibitive. Proper selection by the cardiac team for appropriateness of treatment options for each patient’s circumstances can result in excellent percutaneous coronary intervention and coronary artery bypass graft revascularization outcomes, even in the older adult.

Long-Term Outcomes after CABG with Concomitant CO2 Transmyocardial Revascularization in Comparison with CABG Alone

: Transmyocardial revascularization (TMR) has been used as an isolated or adjunctive revascularization therapy in patients presumed to have nonbypassable coronary artery disease. The purpose of this study is to evaluate the short- and midterm mortality for patients with complete revascularization using TMR and coronary artery bypass grafting (CABG) compared with those patients with incomplete CABG revascularization and to document long-term follow-up in patients receiving TMR + CABG. : Seventy TMR + CABG patients were cohort matched with 70 patients undergoing isolated CABG with circumflex coronary artery disease, but with no bypassable distal targets, from 1999 to 2005 at Emory University Hospital. The data were retrospectively reviewed from a database after being prospectively entered. Results are presented in mean ± standard deviation, and Kaplan-Meier curves were created for long-term all-cause mortality. : The TMR + CABG patients had a similar incidences to the CABG only group for preoperative ejection fraction (50.9 ± 11.2% vs. 50.7 ± 10.3%, P = 0.93), number of grafts (2.6 ± 1.1 vs. 2.5 ± 1.3, P = 0.5), and number of diseased vessels (2.8 ± 0.3 vs. 2.9 ± 0.4, P = 0.26). Off-pump surgery was used more often in the CABG alone group versus the TMR combined with CABG group (74.3% vs. 41.4%, P < 0.001). Postoperatively, there was no statistical difference among the TMR + CABG and the CABG alone groups for intensive care unit length of stay (4.3 ± 7.8 days vs. 2.6 ± 3.4 days, P = 0.026), postsurgical length of stay (7.6 ± 6.1 days vs. 6.8 ± 4.5 days, P = 0.31), stroke events (1.4% vs. 1.4%, P = 1.00), myocardial infarction (4.3% vs. 2.9%, P = 0.65), and 30-day mortality (5.7% vs. 4.3%, P = 0.70). Long-term survival rate was not statistically significant. In addition, 4-year follow-up in the TMR + CABG group had symptom improvement with reduction in New York Heart Association classification for class III/IV (P < 0.0001, baseline vs. 4-year follow-up). : The combination of TMR and CABG for complete revascularization is safe and carries no further risk to patients compared with CABG only. CABG + TMR patients tend to have increased resource utilization. Long-term follow-up shows similar survival between the groups. TMR can be a useful adjunct to CABG for complete revascularization.

Evaluation of Revascularization Subtypes in Octogenarians Undergoing Coronary Artery Bypass Grafting

Recent data suggest that octogenarians' long-term survival after complete coronary artery bypass graft revascularization is superior to incomplete revascularization. Discriminating between variable definitions of "complete" complicates interpretation of survival data. We aimed to clarify octogenarian long-term survival rates by stratifying revascularization subtypes. From 1986 to 2007, 580 patients 80 to 94 years of age underwent coronary artery bypass graft. Functional complete revascularization was defined as at least 1 graft to all diseased coronary vessels with >50% stenosis. Traditional complete revascularization was defined as 1 graft to each major arterial system with at least 50% stenosis. Incomplete revascularization was defined as leaving diseased, ungrafted regions. Revascularization was functional in 279 (48%), traditional in 181 (31%), and incomplete in 120 (21%). Long-term survival was evaluated by Kaplan-Meier analysis. Of 537 operative survivors, there were 402 late deaths. Cumulative long-term survival totaled 2890 patient-years. Late survival (Kaplan-Meier) was similar between functional (mean, 6.8 years) and traditional (6.7 years) groups (P=0.51), but diminished with incomplete (4.2 years) revascularization (P=0.007). Survival by group at 5 years was: 59+/-3% functional, 57+/-4% traditional, and 45+/-5% incomplete. Survival at 8 years was: 40+/-3% functional, 37+/-4% traditional, and 26+/-5% incomplete. To minimize selection bias in patients with limited life expectancy, Kaplan-Meier analysis was repeated including only patients with survival >12 months. Survival was again impaired with incomplete revascularization (P=0.04), and there was no difference between functional and traditional complete revascularization (P=0.73). Bypassing all diseased arterial vessels after revascularization does not afford significant long-term survival advantage compared to a traditional approach. Incomplete revascularization, related to more extensive disease, is associated with an 18% decline in survival. These data suggest that it is important to avoid incomplete revascularization in octogenarians, but the supplementary endeavor required to perform functional complete revascularization does not improve survival.

Unprotected left main revascularization in patients with acute coronary syndromes

In acute coronary syndromes (ACS), the optimal revascularization strategy for unprotected left main coronary disease (ULMCD) has been little studied. The objectives of the present study were to describe the practice of ULMCD revascularization in ACS patients and its evolution over an 8-year period, analyse the prognosis of this population and determine the effect of revascularization on outcome. Of 43 018 patients enrolled in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007, 1799 had significant ULMCD and underwent percutaneous coronary intervention (PCI) alone (n = 514), coronary artery bypass graft (CABG) alone (n = 612), or no revascularization (n = 673). Mortality was 7.7% in hospital and 14% at 6 months. Over the 8-year study, the GRACE risk score remained constant, but there was a steady shift to more PCI than CABG over time. Patients undergoing PCI presented more frequently with ST-segment elevation myocardial infarction (STEMI), after cardiac arrest, or in cardiogenic shock; 48% of PCI patients underwent revascularization on the day of admission vs. 5.1% in the CABG group. After adjustment, revascularization was associated with an early hazard of hospital death vs. no revascularization, significant for PCI (hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.62-4.18) but not for CABG (1.26, 0.72-2.22). From discharge to 6 months, both PCI (HR 0.45, 95% CI 0.23-0.85) and CABG (0.11, 0.04-0.28) were significantly associated with improved survival in comparison with an initial strategy of no revascularization. Coronary artery bypass graft revascularization was associated with a five-fold increase in stroke compared with the other two groups. Unprotected left main coronary disease in ACS is associated with high mortality, especially in patients with STEMI and/or haemodynamic or arrhythmic instability. Percutaneous coronary intervention is now the most common revascularization strategy and preferred in higher risk patients. Coronary artery bypass graft is often delayed and performed in lower risk patients, leading to good 6-month survival. The two approaches therefore appear complementary.

Off-pump Exchange of Short-term Percutaneous Ventricular Assist Device (VAD) to Long-term Implantable VAD in Severe Coagulopathy and Multi-organ Failure

Ventricular support in patients with end-stage heart failure can be achieved using intracorporeal left ventricular assist device (LVAD) or percutaneous ventricular assist device (pVAD) systems. Multiple efforts have been made to minimize procedure-associated complications. We present a case report of an off-pump insertion of a MicroMed DeBakey VAD after Tandem Heart support using a previous sternotomy incision. A 47-year-old woman with end-stage heart failure after coronary artery bypass graft revascularization was admitted for pharmacologic treatment. She developed multi-organ failure and a severe coagulopathy with thromboembolic complications. Heparin-induced thrombocytopenia (HIT) was suspected. A percutaneous Tandem Heart was placed, the patient's condition stabilized, and finally a MicroMed DeBakey Child VAD was implanted off-pump, re-opening a previous sternotomy incision. To avoid the need for heparinization in the light of HIT and severe coagulopathy, the LVAD implantation was performed under Tandem Heart support without cardiopulmonary bypass. The patient has been anti-coagulated with angiomax ever since. Critically ill patients with end-stage heart disease, multi-organ failure, severe coagulopathy and a previous median sternotomy can be bridged from a Tandem Heart to MicroMed DeBakey VAD without cardiopulmonary bypass using the previous incision, provided there are few adhesions and stable hemodynamic conditions.

Clinical Predictors of Appropriate Implantable‐Cardioverter Defibrillator Discharge

The implantable cardioverter-defibrillator (ICD) is the mainstay of treatment for ventricular tachyarrhythmias due to its impact on mortality. ICD discharges may be appropriate or inappropriate, and identification of patients at risk for ICD discharge is essential. We sought to determine the predictors of appropriate ICD discharge. We analyzed data from 591 ICD recipients (mean age 67.9 +/- 13.0 years; 474 men; mean follow-up 10.9 +/- 13.8 months). The association between ICD discharges and multiple clinical variables, including age, gender, hypertension, diabetes, coronary artery bypass graft (CABG) surgery, syncope, atrial fibrillation (AF), prior coronary intervention, left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension, left ventricular end systolic dimension (LVESD), and ambient drug therapy was examined. The rates of appropriate or inappropriate discharges, delivered to 155 patients, were 0.49 per follow-up year (F/Y). The median time-to-first appropriate discharge was 3.4 years. Among the discharges delivered, 97(63%) were appropriate and 58(37%) were inappropriate. Risk factors associated with a trend toward earlier appropriate discharges included age </= 65 years, and diuretic and digitalis use. By multiple variable analysis, no history of CABG and an enlarged LVESD were independent predictors of earlier appropriate ICD discharge. Patients who did not have CABG revascularization were 2.8-fold more likely than those who underwent CABG, and patients with enlarged LVESD were 2.5-fold more likely than those with normal LVESD to receive appropriate ICD discharges. These patients deserve special vigilance and management in order to prevent the occurrence of ventricular tachyarrhythmias triggering ICD discharges.

Trainees operating on high-risk patients without cardiopulmonary bypass: a high-risk strategy?

BackgroundThe safety of teaching off-pump coronary artery bypass grafting to trainees is best tested in high-risk patients, who are more likely to experience significant morbidity after surgery. This study compared outcomes of off-pump coronary artery bypass grafting operations performed by consultants and trainees in high-risk patients. MethodsData for consecutive patients undergoing off-pump coronary artery bypass grafting were collected prospectively. Patients satisfying at least one of the following criteria were classified as high-risk: age older than 75 years, ejection fraction less than 0.30, myocardial infarction in the previous month, current congestive heart failure, previous cerebrovascular accident, creatinine greater than 150 μmol/L, respiratory impairment, peripheral vascular disease, previous cardiac surgery, and left main stem stenosis greater than 50%. Early morbidity, 30-day mortality, and late survival were compared. ResultsFrom April 1996 to December 2002, 686 high-risk patients underwent off-pump coronary artery bypass grafting revascularization. Operations by five consultants (416; 61%) and four trainees (239; 35%) were the focus of subsequent analyses. Nine visiting or research fellows performed the other 31 operations. Prognostic factors were more favorable in trainee-led operations. On average, consultants and trainees grafted the same number of vessels. There were 18 (4.3%) and 5 (1.9%) deaths within 30 days, and 14 (3.4%) and 5 (1.9%) myocardial infarctions in consultant and trainee groups, respectively. After adjusting for imbalances in prognostic factors, odd ratios for almost all adverse outcomes implied no increased risk with trainee operators, although patients operated on by trainees had longer postoperative stays and were more likely to have a red blood cell transfusion. Kaplan-Meier cumulative mortality estimates at 24-month follow-up were 10.5% (95% confidence interval, 7.7% to 14.2%) and 6.4% (95% confidence interval, 3.8% to 10.9%) in consultant and trainee groups, respectively (hazard ratio = 0.60 [95% confidence interval, 0.37 to 0.99]; p = 0.05). ConclusionsOff-pump coronary artery bypass grafting surgery in high-risk patients can be safely performed by trainees.

Effect of surgical revascularization in patients with coronary artery disease and ventricular tachycardia or fibrillation in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Registry

Background Patients who undergo resuscitation from near-fatal ventricular arrhythmias often have significant coronary artery disease, and revascularization has been shown to reduce myocardial ischemia and cardiac arrest episodes in this patient population. The magnitude of benefit attributed to revascularization has varied by study, and the use of adjunct implantable cardioverter defibrillator (ICD) therapy has not been well-characterized. Methods and Results The Antiarrhythmics Versus Implantable Defibrillators (AVID) registry included 3117 patients with life-threatening ventricular arrhythmias, of whom 2321 (77%) had documented coronary artery disease and 281 (17%) underwent a coronary artery bypass grafting revascularization procedure after the index event. Patients who underwent a revascularization procedure were younger, had a lower incidence rate of prior myocardial infarction and ventricular arrhythmia, had a higher left ventricular ejection fraction, had less congestive heart failure, and were more likely to have had ventricular fibrillation as the presenting arrhythmia. Patients who underwent revascularization had a better survival rate than did those who did not undergo such a procedure after the index event, and adjustment for differing baseline patient covariates did not alter the relative survival rate benefit. Further, ICD implantation offered a similar survival rate advantage to those patients in the AVID registry with coronary artery disease independent of revascularization. Conclusion Coronary revascularization in the AVID registry patients with coronary artery disease effected a survival rate benefit that was not attributable to differences in baseline patient characteristics. The benefit of ICD on patient survival rate was not attenuated by a revascularization procedure. (Am Heart J 2002;143:821-6.)

Optimização da perviabilidade do enxerto venoso na revascularização miocárdica: compreensão da fisiopatologia, novas drogas e avanços técnicos

Objetivo: Baseado nos modernos conceitos do comportamento endotelial do enxerto venoso, o objetivo deste trabalho foi identificar quais os principais fatores de obstrucao no periodo imediato da cirurgia, quais e quando ocorrem as modificacoes morfologicas tardias e, finalmente, apontar os recursos aplicaveis para optimizar a perviabilidade imediata e tardia dos enxertos venosos. Casuistica e Metodos: No periodo de 1971 a 1998 foram operados 3116 pacientes de revascularizacao miocardica. Estes procedimentos foram analisados em tres grupos- grupo I onde somente se empregou veia safena; grupo II onde somente se empregou arteria toracica interna e grupo III onde se empregou a associacao de veia safena e arteria toracica interna. A incidencia de reoperacoes foi analisada procurando identificar a perviabilidade dos diferentes enxertos e seus resultados. Foi realizada uma analise estatistica empregando-se o teste de Qui-quadrado para averiguar a existencia de diferencas de reoperados e mortalidade entre os tres grupos. Resultados: O indice de mortalidade imediata variou de 1 a 7% no grupo I para 3,8 % no grupo II demonstrando diferenca estatisticamente significativa (p= 0,0401). Foram reoperados 255 pacientes, sendo 3,8% no grupo II e 8,1% no grupo I demonstrando diferenca estatisticamente significativa (p= 0,0094). Conclusoes: Os resultados imediatos com os enxertos venosos dependem do manuseio cirurgico, retirada. e preparo da veia, confeccao das anastomoses e qualidade das arterias coronarias. Os resultados tardios entre o quinto e decimo anos sofrem a influencia do espectro da aterosclerose. Os enxertos venosos representam maior incidencia de reoperacoes quando comparados com os enxertos arteriais. Os enxertos venosos podem aumentar o grau de perviabilidade atraves da limitacao do manuseio da veia safena, emprego de drogas como verapamil, triglicerina, papaverina, aprotinina, da profilaxia da aterosclerose e da uniformizacao da luz das veias irregularmente dilatadas atraves de enxertos tubulares hibridos.

Ischemic heart disease in the elderly: the role of coronary angioplasty and coronary artery bypass grafting.

Management of ischemic heart disease in the elderly is complex. Invasive therapies such as percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are associated with significant morbidity and mortality. The short-term advantage of PTCA is that its associated noncardiac morbidity and mortality are less than that of CABG, particularly in the incidence of stroke. Unfortunately, PTCA revascularization is less complete and less durable than CABG revascularization. The advantages of CABG are that cardiac revascularization is more complete, the result is more durable, and long-term results are improved over those of PTCA. Conversely, the initial morbidity and mortality are higher for CABG and are adversely affected by factors such as recent myocardial infarction, lung disease, and renal failure. We provide an overview of the results and outcomes of PTCA and CABG in the elderly, as well as suggestions for management.