coronary revascularization with the left internal thoracic artery and radial artery: comparison of short-term clinical evolution between elective and emergency surgery revascularização coronariana com uso de artéria torácica interna esquerda e artéria radial esquerda: estudo comparativo da evolução clínica imediata entre cirurgias eletivas e emergências

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ID: 188934
2005
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Abstract
BACKGROUND: Left internal thoracic artery-to left anterior descending artery grafting has become a fundamental part of coronary artery bypass grafting. This grafting has led to increased use of other arterial conduits, of which the radial artery is most popular. Whether radial grafting can be used in the emergency patient is not known. This study compares the short-term clinical evolution between elective vs emergency coronary artery bypass grafting surgery with left internal thoracic artery and radial artery. METHODS: A retrospective study of 47 patients who underwent elective or emergency coronary artery bypass grafting from 1996 to 2003. All patients had coronary stenosis >70% in all target vessels. Only the left internal thoracic artery and radial artery were used as grafts. Patients were divided into elective group (23 patients) and emergency group (24 patients). Emergency criteria were unstable angina and/or critical coronary stenosis with high risk for acute myocardial infarction. Groups were similar for age and number of diseased vessels. RESULTS: The mean number of left internal thoracic artery grafts per patient in the elective and emergency groups were respectively 1.17 and 1.38 (P = .17). The mean number of radial artery grafts per patient in the elective and emergency groups was respectively 2.26 and 2.08 (P = .48). The 30-day mortality was 0. There was no postoperative cardiogenic shock. The elective group had 1 acute myocardial infarction (4.4%) postoperatively, and emergency group had 5 (20.8%). A nonsignificant trend towards acute myocardial infarction was noted in the emergency group (P = .18). Intensive care unit and postoperative stay were similar in both groups. CONCLUSION: Coronary artery bypass grafting using left internal thoracic artery and radial artery accomplishing complete revascularization can be performed in emergency patients with results similar to those for elective patients.
O uso de artéria torácica interna esquerda para descendente anterior se tornou fundamental na revascularização do miocárdio. Este enxerto levou ao aumento da utilização de enxertos arteriais, dos quais a artéria radial é muito popular. O uso de artéria radial em pacientes de emergência foi pouco estudado. Este estudo compara a evolução clínica imediata entre revascularização do miocárdio eletiva vs. emergência com artéria torácica interna esquerda e artéria radial. MATERIAL E MÉTODOS: Estudo retrospectivo de 47 pacientes que se submeteram a revascularização do miocárdio eletiva ou de emergência entre 1996 e 2003. Apresentavam estenose crítica (>70%) em todas as artérias alvo. Apenas a artéria torácica interna esquerda e a artéria radial foram utilizadas. Os pacientes constituíram dois grupos: eletivo (23 casos) e emergência (24 casos). Critérios de emergência foram angina instável e/ou estenose coronariana crítica com alto risco de infarto agudo do miocárdio. Os grupos eram homogêneos para idade e artérias acometidas. RESULTADOS: A média de enxertos de artéria torácica interna esquerda por paciente eletivo e de emergência foi respectivamente 1,17 e 1,38 (P=.17). A média de enxertos de artéria radial por paciente eletivo e de emergência foi respectivamente 2,26 e 2,08 (P=.48). A mortalidade até 30 dias foi zero. No pós-operatòrio não ocorreram casos de choque cardiogênico. Um paciente eletivo (4,4%) e 5pacientes de emergência (20,8%) apresentaram infarto agudo do miocárdio no pós-operatório; tendência não significativa para ocorrência de infarto agudo do miocárdio no grupo de emergência (P=.18). Tempo de internação na unidade de terapia intensiva e hospitalar foi semelhante nos dois grupos. CONCLUSÃO: A revascularização do miocárdio com utilização de artéria torácica interna esquerda e artéria radial pode ser realizada em pacientes de emergência com resultados equivalentes aos pacientes eletivos.
Reference Key
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Authors Roberto Rocha-e-Silva, Antônio de Pádua Mansur, José Fabri Junior, Rogério Bicudo Ramos, Carlos Edson Campos Cunha Filho, Luis Alberto Oliveira Dallan, Sérgio Almeida de Oliveira
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Journal icitacee 2015 - 2nd international conference on information technology, computer, and electrical engineering: green technology strengthening in information technology, electrical and computer engineering implementation, proceedings
Year 2005
DOI
10.1590/S1807-59322005000300008
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322005000300008
Keywords
emergency radial artery arterial conduits

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