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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 February;42(1):23-6

lingua: Inglese

Surgical myocardial revascularization (CABG) in patients with pulmonary disease: beating heart versus cardiopulmonary bypass

Covino E., Santise G., Di Lello F., De Amicis V., Bonifazi R., Bellino I., Spampinato N.

From the Department of Cardiac Surgery Medical School, University of Naples “Federico II”, Italy


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Background. Adverse ­effects on the res­pir­a­to­ry ­system can be ­severe in ­many instanc­es ­after coron­arv ­artery ­bypass graft­ing (­CABG) ­with car­di­o­pul­mo­nary ­bypass (CPBP). Recently, oper­a­tive tech­niques with­out ­CPBP ­have ­gained wide­spread con­sent, ­thanks to the new­ly devel­oped retrac­tors ­that ­allow sat­is­fac­to­ry immo­bil­isa­tion of the sur­gi­cal ­field.
Methods. Thirty-sev­en ­patients oper­at­ed ­upon in our Institution ­between April 1997 and April 1998 ­showed an obstruc­tive and/or restric­tive pul­mo­nary dis­ease. Twenty-one ­patients ­were oper­at­ed on with­out ­CBPB (­group A), ­while 16 ­patients ­were oper­at­ed ­using ­CPBP (­group B, con­trol). The allo­ca­tion in ­each ­group had ­been ran­dom­ised.
Results. The ­length of the oper­a­tion in ­group A was ­less ­than in ­group B (196±35 min­utes vs 235±60 min­utes), (p=0.014). A sig­nif­i­cant dif­fer­ence was ­found in post­op­er­a­tive bleed­ing: 562±381 ml vs 776±378 (p=0.046), in post­op­er­a­tive red ­cell ­count, hemo­glo­bin lev­el and Hct. Permanence on the ven­ti­la­tor was 19.1±13 ­hours in ­group B and 13.1±6.1 ­hours in ­group A (p=0.03). The ­length of ­stay in ICU was sig­nif­i­cant­ly dif­fer­ent: 33.8±16.2 ­hours for ­group A vs 53.6±29.3 ­hours for ­group B (p=0.01). No res­pir­a­to­ry fail­ure ­occurred in ­group A; two ­patients expe­ri­enced ­slow wean­ing ­from ven­ti­la­tion assis­tance and one ­died ­from ­that com­pli­ca­tion in ­group B.
Conclusions. Myocardial revas­cu­lar­iza­tion with­out ­CPBP ­allows a bet­ter post­op­er­a­tive clin­i­cal ­course in ­patients ­with ­advanced pul­mo­nary dis­ease.

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