On-pump versus off-pump coronary artery bypass graft surgery. What do the evidences show?

نویسندگان

  • Alfredo José Rodrigues
  • Paulo Roberto Barbosa Évora
  • Paulo Victor Alves Tubino
چکیده

The main purpose of the off-pump coronary artery bypass surgery is to reduce morbidity and mortality due cardiopulmonary bypass. However, even though many studies have shown that off-pump coronary artery bypass is feasible and provides hospital morbidity and mortality similar to the on-pump coronary artery bypass graft surgery, probably better in some aspects, its long-term results have been questioned, since some trials have shown reduced survival with off-pump coronary artery bypass. It is likely that incomplete revascularization and/or poor graft patency with off-pump coronary artery bypass probably are responsible for such unfavorable outcome. Descriptors: Myocardial revascularization. Coronary artery bypass. Coronary artery bypass, off-pump. Evidence-based medicine. Resumo A proposta da revascularização do miocárdio sem emprego da circulação extracorpórea visa à diminuição da morbimortalidade decorrente dos potenciais efeitos deletérios da circulação extracorpórea. Todavia, embora a maioria dos estudos demonstre que a revascularização sem circulação extracorpórea é factível e forneça resultados similares à operação com circulação extracorpórea, no que se refere à morbimortalidade hospitalar, e pode mesmo diminuir a incidência de alguns eventos, sua eficácia a médio e longo prazo tem sido questionada. Alguns estudos demonstram menor sobrevida em pacientes submetidos à revascularização do miocárdio sem circulação extracorpórea, levantando a hipótese de que a revascularização incompleta e/ou a pior evolução dos enxertos realizados na operação sem circulação extracorpórea em comparação à operação com circulação extracorpórea, observadas em alguns estudos, seriam responsáveis por essa evolução desfavorável. Descritores: Revascularização miocárdica. Ponte de artéria coronária. Ponte de artéria coronária sem circulação extracorpórea. Medicina baseada em evidências.

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عنوان ژورنال:

دوره 28  شماره 

صفحات  -

تاریخ انتشار 2013