Publications (8)18.7 Total impact
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Article: Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score-matched follow-up study.
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ABSTRACT: OBJECTIVE: The aim of our study was to evaluate the long-term outcome of patients exclusively undergoing total arterial revascularization off-pump coronary artery bypass grafting and to compare the performance of the radial artery and the right internal thoracic artery as a second conduit. METHODS: We studied a consecutive series of 1700 patients undergoing off-pump coronary artery bypass grafting, receiving a radial artery or right internal thoracic artery as a second graft for total arterial revascularization, between 2003 and 2010. A total of 1447 patients (85.11%) received bilateral internal thoracic artery grafting, and 253 patients (14.89%) received left internal thoracic artery and radial artery grafting. A propensity score-matched analysis was performed to compare the 2 groups, bilateral internal thoracic artery and left internal thoracic artery and radial artery, relative to overall survival, morbidity, and combined end points event-free survival. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated by Cox regression. RESULTS: In the full unmatched patient population, the postoperative survival (HR, 0.59; 95% CI, 0.38-0.92; P = .021), incidence of reintervention/readmission (HR, 0.42; 95% CI, 0.28-0.61; P < .001), and combined end points (HR, 0.47; 95% CI, 0.35-0.63; P < .001) were significantly better in the bilateral internal thoracic artery group. In the propensity score-matched patient population, the incidence of reintervention/readmission (HR, 0.40; 95% CI, 0.18-0.88; P = .02) and combined end points (HR, 0.54; 95% CI, 0.32-0.92; P = .02) were significantly better in the bilateral internal thoracic artery group compared with the left internal thoracic artery-radial artery group. CONCLUSIONS: The results of our study provide evidence for the superiority of the right internal thoracic artery graft compared with the radial artery as a second conduit in total arterial revascularization off-pump coronary artery bypass grafting.The Journal of thoracic and cardiovascular surgery 04/2013; · 3.41 Impact Factor -
Article: Immediate extubation after off-pump coronary artery bypass graft surgery in 1,196 consecutive patients: feasibility, safety and predictors of when not to attempt it.
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ABSTRACT: The purpose of this study was to evaluate the feasibility and safety of immediate extubation (ultrafast-track anesthesia [UFTA]) in the operating room, and the predictors of when not to attempt it in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Case series. A private hospital. One thousand one hundred ninety-six patients undergoing OPCAB surgery, representing 4 years of a single anesthesia service's practice (3 anesthesiologists), were evaluated for immediate extubation. All patients were considered amenable to immediate extubation if specific criteria were met. Patients received general anesthesia (UFTA protocol) and underwent off-pump coronary artery bypass graft surgery. One thousand sixty-five patients (89%) met extubation criteria and were extubated successfully in the operating room. By multivariate analysis, the following independent predictors of avoiding immediate extubation were identified: reoperation (odds ratio [OR] = 3.9, p < 0.001), pre-existing renal disease (OR = 3.1, p < 0.0001), diabetes (OR = 1.7, p < 0.007), preoperative intra-aortic balloon pump placement (OR = 7.4, p < 0.0001), and total surgical time (OR = 3.7, p < 0.0001). Patients who met extubation criteria had lower in-hospital reintubation (2.5% v 16%, p < 0.001), myocardial infarction (1.03% v 4.58%, p = 0.001), renal insufficiency (2.2% v 7.63%, p < 0.001), stroke (0.4% v 2.29%, p = 0.032), and mortality rates (1.2% v 10.7%, p < 0.001) than patients who did not. UFTA is feasible and safe in most patients undergoing OPCAB surgery. Baseline and intraoperative data predicted when immediate extubation should not be attempted.Journal of cardiothoracic and vascular anesthesia 10/2010; 25(3):431-6. · 1.06 Impact Factor -
Article: Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations.
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ABSTRACT: The presence of large lead vegetations poses additional difficulties for explantation because many methods cannot be used due to the potential hazard of embolism. We report two patients with large vegetation on the ventricular lead due to endocarditis and one of them with an atrial septal defect associated. It was applied a combined technique of transvenous lead removal and sternotomy with cardiopulmonary bypass for the complete removal of pacemaker wires. This procedure resolved the pacemakers endocarditis safely and subsequently a new transvenous device was placed on the opposite site.Brazilian Journal of Cardiovascular Surgery 12/2009; 24(4):570-3. -
Article: Impact of preoperative clopidogrel in off pump coronary artery bypass surgery: a propensity score analysis.
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ABSTRACT: The aim of our study was to evaluate the impact of recent clopidrogel use before off-pump coronary artery bypass grafting on the postoperative risk of bleeding. During the period January 2003 to December 2006, 1104 consecutive patients underwent off-pump coronary artery bypass grafting. Patients were divided into two groups according to the recent use of clopidrogel (within 7 days). We performed a propensity score to further adjust for differences between the patients with and without recent use of clopidrogel. Mean age was 64 +/- 14 years and 87% were male. The clopidrogel group had a greater incidence of patients in unstable condition, requiring emergency coronary bypass grafting, and with a high EuroSCORE. Propensity score analysis selected 88 patients with and 176 without recent use of clopidrogel. By propensity score, the clopidrogel group had higher requirements for fresh frozen plasma units (18.1% vs 8.5%; P = .02), reoperation owing to bleeding (5.6% vs 0.5%; P = .009), and higher need for postoperative mechanical ventilation (4% vs 10%; P = .04), whereas mortality and length of stay were similar between groups. Recent use of clopidogrel before off-pump coronary artery bypass grafting is associated with greater risk for bleeding with similar mortality rate.The Journal of thoracic and cardiovascular surgery 03/2009; 137(2):309-13. · 3.41 Impact Factor -
Article: Total arterial off-pump coronary revascularization using bilateral internal thoracic arteries in triple-vessel disease: surgical technique and clinical outcomes.
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ABSTRACT: This was a single-institutional study about total arterial off-pump coronary artery bypass graft surgery (OPCABG) using bilateral internal thoracic arteries in triple-vessel disease. We retrospectively reviewed the records of 569 multivessel CABG patients (10% female) who underwent total arterial (bilateral internal thoracic arteries) OPCABG between January 2002 and December 2006. Mean age was 63.9 +/- 8.9 years. All patients included underwent OPCABG as an elective procedure. Postoperative angiograms were evaluated during a postoperative follow-up period. Early and midterm outcomes, including overall patient survival, freedom from readmission and reintervention, freedom from the combined endpoint of cardiac events and quality of life, were evaluated. Multivariate analysis was used to find determinants of late death. Overall survival and freedom from combined endpoints were determined by the Kaplan-Meier method. The average number of distal anastomoses per patient was 3.18 +/- 0.4. The average operation time was 209.7 +/- 41.7 minutes. Thirty-day mortality was 0.88% (5 of 569). Overall patency rate for all grafts studies was 94.3% (632 of 670). Mean follow-up time was 810 days (range, 8 days to 61 months). Cumulative patient survival at 4 years was 93.3% +/- 1.9%. Significant predictors of late mortality were age (hazard ratio, 1.06; 95% confidence interval: 1.01 to 1.12), previous stroke (hazard ratio, 6.5; 95% confidence interval: 1.8 to 23.5), and moderate to severe left ventricle ejection fraction (hazard ratio, 3.3; 95% confidence interval: 1.2 to 8.8). Freedom from hospital readmission and reintervention at 4 years was 91.7% +/- 3.5%. Freedom from combined endpoint (death, hospital readmission, and reintervention) at 4 years was 86.9% +/- 3.6%. There was a marked improvement in patients' quality of life at follow-up (Duke Activity Status Index score > 45 in more than 70% patients). Total arterial (bilateral internal thoracic arteries) OPCABG is feasible with a safe outcome in terms of hospital mortality. At follow-up the incidence of death, hospital readmission and reintervention and patients' quality of life are acceptable with favorable graft patency rates.The Annals of thoracic surgery 08/2008; 86(2):524-30. · 3.74 Impact Factor -
Article: Parasternal approach for redo in ascending aorta pseudoaneurysm.
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ABSTRACT: Aortic ascending pseudoaneurysm is a rare complication following aortic root surgery. The surgical solution of the complication is rather demanding and complex, especially when reaching the mediastinum. The latter translates into an elevated morbidity and mortality. We present a case performed through a minimal anterior right thoracotomy, which allowed us to dissect between the pseudoaneurysm and the internal site of the sternum as a first step prior to a second sternotomy. By using this approach, we minimized bleeding risks and the possibility of aortic rupture. This technique could have the potential to be generally applicable in this complication after further evaluation.Brazilian Journal of Cardiovascular Surgery 07/2008; 23(2):279-82. -
Article: Is early anticoagulation necessary after biological aortic valve replacement?
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ABSTRACT: Early antithrombotic therapy after biological aortic valve replacement (AVR) is controversial. The aim of this study was to determine the rate of thromboembolic events (TE) without anticoagulation treatment during the first 3 months after surgery. Out of 143 consecutive patients who underwent biological AVR from January 1998 to December 2004, 127 patients who did not receive anticoagulation were included (89%). Events during the first 3 months after surgery included: 2 strokes (1.5%), 2 major bleedings (1.5%) and 9 deaths (7%) (none of them due to TE). In conclusion, the management of patients without antithrombotic treatment after biological AVR seems to be safe due to a low rate of TE.International journal of cardiology 01/2008; 128(3):422-3. · 7.08 Impact Factor -
Article: Cirugía coronaria con conductos arteriales múltiples sin circulación extracorpórea
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ABSTRACT: RESUMEN Objetivo Analizar los resultados intrahospitalarios en pacientes sometidos en forma electiva a revascularización arterial total sin circulación extracorpórea (sin CEC) e identificar predictores de morbimortalidad con esta estrategia quirúrgica. Material y métodos Entre mayo de 1999 y febrero de 2004 se realizaron 203 cirugías de revascularización miocárdica (CRM) con revascularización arterial total sin CEC, en pacientes con enferme-dad de múltiples vasos (tres vasos 81,7%, enfermedad de 1 vaso excluida). Se comunican variables preoperatorias y comorbilidad: edad promedio 63,9 ± 9,13 años, hombres 182 (89,5%), hipertensión 132 (65%), tabaquismo 125 (61%), hipercolesterolemia 152 (74,8%), IAM previo (más de 30 días) 73 (35%), disfunción ventricular moderada a severa 31 (15%), reoperación 5 (2,5%). La revascularización arterial total incluyó anastomosis en T y secuenciales con mamaria interna izquierda (100%), mamaria interna derecha (56,6%) y arteria radial (63%). El número total de anastomosis distales fue de 576 (mediana de 3 puen-tes/paciente), todas realizadas con estabilizadores mecánicos externos. No se realizaron anastomosis proximales en la aorta. Se convirtieron a cirugía con CEC 3 pacientes (1,5%). El 90% de los pacientes fueron extubados en la sala de operaciones. Para el análisis estadístico se utilizó la prueba de regresión logística múltiple. Resultados La incidencia de fibrilación auricular posoperatoria fue del 12,8% (26), insuficiencia renal oligoanúrica 3% (6), diálisis 0,49% (1), infarto de miocardio posoperatorio 1,47% (3), bajo gasto cardíaco 4% (8), reoperación por sangrado 1,47% (3), mediastinitis 1,47% (3), acciden-te cerebrovascular 1,47% (3). La mortalidad intrahospitalaria fue del 2,45% (5). El único predictor independiente de morbilidad a los 30 días fue la edad (p = 0,033; OR 1,04; IC 95%: 1-1,08). Conclusión La cirugía de revascularización miocárdica sin circulación extracorpórea utilizando conduc-tos arteriales para la enfermedad de múltiples vasos es factible con baja morbimortalidad a los 30 días. REV ARGENT CARDIOL 2004;72:426-432.
