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ORIGINAL ARTICLE

Technique and results of coronary endarterectomy

Pedro R SalernoI; Jarbas J DinkhuysenI; Paulo ChaccurI; Camilo Abdulmassih NetoI; Magaly A SantosI; Luiz Carlos Bento de SouzaI; Adib D JateneI

DOI: 10.1590/S0102-76381994000300004

ABSTRACT

The surgical approach to coronary artery disease has improved a lot during the past two decades. With the widespread use of balloon angioplasty, a growing percentage of surgical patients, have complex coronary pathology. In properly selected patients, coronary endarterectomy has been a valuable adjunt to bypass techiniques by removing obstructing lesions and preparing the distal artery for bypass grafting. Over a 5 years period (1988 to 1993), 2781 patients underwent surgical revascularization at our Instituition (Hospital do Coração). Coronary artery bypass combined with coronary endarterectomy was done in 110 patients. There were 99 men (90%) and 11 women, mean age 58.9 years. For comparation patients were placed into two groups: Group A, patients undergoing endarterectomy to one artery, 104 patients - 94.5%. Group B, patients with more than one endarterectomy - 6 patients 5.4%. Perioperative myocardial infarction envolving the area supplied by the endarterectomized artery occurred in 6.3%, (7 patients). In 3 (2.7%) the infarction was not related with the endarterectomized artery. Complications during the post-operative period were: arrhythmia in 26 patients (23.6%), return to the operation room for control of bleeding in 12 (10.9%), acute renal failure in 10 (9%), and low cardiac output in 4 (3.6%) patients. Operative mortality rate was 4.5% (5/110), due to low cardiac output and multiple organs failure; 4 (3.8%) patients belonged to Group A and 1 to Group B (16.6%). This study demostrates that multiple bypass grafting and adjunt coronary endarterectomy, can yeld good clinical results in patients with difuse coronary artery disease, many of whom would otherwise be inoperable.

RESUMO

A abordagem cirúrgica da doença coronária sofreu grandes modificações nos últimos anos. Devido à possibilidade de angioplastia, os doentes encaminhados para cirurgia são aqueles com doença ateromatosa difusa grave e/ou com artérias ocluídas, geralmente responsável por uma área de músculo viável. Assim sendo, a endarterectomia de coronária é um recurso técnico que viabiliza a abordagem destes vasos. Em nosso Serviço, no Hospital do Coração, foram submetidos para cirurgia de revascularização do miocárdio (RM) com endarterectomia, no período de janeiro de 88 a dezembro de 92,110 pacientes(pts.). O sexo masculino predominou, com 99 (90%) pts. Encontramos com função ventricular normal 33 (30%), déficit moderado 71 (64,5%) e severo 6 (5,4%). Doze (10,9%) pts. eram reintervenção para nova RM. Dividimos em 2 grupos quanto ao número de endarterectomias realizadas. Grupo A com uma endarterectomia 104 (94,5%) pts. e Grupo B com mais de uma endarterectomia 6 (5,4%) pts. No Grupo A a coronária esquerda (CE) foi abordada em 38 (36,5%) pts. e a coronária direita (CD) 66 (63,4%) pts. No Grupo B com mais de uma endarterectomia a CE foi abordada 8 vezes e a CD outras 4. Em todos os casos o cirurgião removeu a endoartéria com a placa ateromatosa, com sucesso. A ocorrência de infarto trans-operatório na região da artéria endarterectomizada foi de 7 (6,3%) pts. e em regiões não relacionadas com as artérias manipuladas foi de 3 (2,7) pts. Em 9 (8,1 %) pts. foi realizado procedimento associado, como: aneurismectomia do ventrículo esquerdo 5 (4,5%) pts., troca de valva aórtica 1 (0,9%) e ventrículotomia para retirada de trombo em 3 (2,7%). As complicações mais freqüentes foram: arritmias 26 (23,6%) pts., insuficiência renal aguda 10 (9%) pts., síndrome de baixo débito (SBD) 4 (3,6%) pts. Ocorreram 5 (4,5%) óbitos, tendo como causa mais freqüente a SBD. Quatro (3,8%) pts., do Grupo A e 1 (16,6%) do Grupo B. Com esses resultados, verificamos que a endarterectomia é um procedimento que, utilizado criteriosamente, possibilita uma RM completa e com resultados consistentes.
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