RBCCV Brazilian Journal of Cardiovascular Surgery Revista Brasileira de Cirurgia Cardiovascular

Objective: To describe patient selection criteria, surgical technique and early outcomes in patients undergoing reoperative coronary artery bypass surgery (RECABG) through a left thoracotomy without cardiopulmonary bypass (CPB). Methods: Eight patients with patent grafts to the left interventricular coronary artery (four of whom had also patent grafts to the right coronary artery) requiring revascularization of the circumflex coronary system had redo-CABG without CPB through a left posterolateral thoracotomy. Results: There were no in-hospital mortality or serious postoperative complications. All patients are angina-free. Conclusions: An off-pump redo-CABG through a left posterolateral thoracotomy may reduce risks attributable to resternotomy in patients who met the selection criteria.

Keywords: Myocardial revascularization. Reoperation. Coronary artery bypass, methods. Thoracotomy.

Objective: To evaluate short-term and medium-term results of intracardiac correction of Tetralogy of Fallot in the first year of life. Methods: From January 1996 to October 2004, 67 consecutive infants ranging in age from 1 to 11 months (mean: 7.2 months) and weighing from 4 to 10 kilograms (mean: 7.1 kilograms) underwent elective total correction of Tetralogy of Fallot. The surgery was accomplished with conventional cardiopulmonary bypass and moderate hypothermia. Right ventriculotomy was performed in 60 (89.5%) cases and an atriopulmonary approach was used in the other seven (10.5%) cases. Results: Cardiopulmonary bypass time ranged from 35 to 147 minutes (mean: 78.8 ± 21 minutes), and aortic clamping time ranged from 25 to 86 minutes (mean: 51.8 ± 15.6 minutes). Transannular enlargement of the right ventricular outflow tract was needed in 50 (64.1%) patients. Gradient between the right ventricle and pulmonary artery after correction varied from 0 to 54 mmHg (mean: 15.5 ± 10.8 mmHg). There were two (2.98%) early deaths. Follow-up of the 65 survivors ranged from 7 to 115 months (mean:44.0 ± 35 months). There was one late noncardiac death. All other patients are asymptomatic. The actuarial survival curve at 12 years, including operative mortality, was 97%. Ten patients were evaluated by magnetic nuclear angioresonance. Conclusions: Intracardiac correction of Tetralogy of Fallot in the first year of life may be performed with low morbidity and mortality and good late results.

Keywords: Tetralogy of Fallot/surgery. Heart defects, congenital. Treatment outcome. Child. Follow-up studies.