deathcom multimédia

Enio Buffolo
AATS International Coronary
State of the Art Surgical Coronary Revascularization
New York – August 2015
Full Professor Cardiovascular Surgery
Paulista-School of Medicine
Federal University of Sao Paulo
Historical Perspectives
On 25 February 1964, Kolesov
performed the first successful clinical
CABG
3
FIRST ATTEMPTS
KOLESOV (URSS) ................ 1967 J. Thorac. Cardiov. Surg.
TRAPP & BISARYA (CAN) ... 1975 AnnThorac. Surg.
ANKENEY (USA) .................. 1975 AnnThorac. Surg.
4
5
Porcentagem de Variação
45
PDA
30
Fluxo Coronário Médio
15
PO2M
PO2SCK
0
PO2SCV
-15
-30
Representação gráfica da variação relativa dos valores médios da pressão diastólica
da aorta (PDA), fluxo coronário médio, tensão de oxigênio intramiocárdico (PO2M),
tensão de oxigênio do sangue retirado com fluxo constante do seio coronário
(PO2SCK), tensão de oxigênio do sangue que flui livremente pelo seio coronário
(PO2SCV), após a infusão de verapamil.
Cicogna – Tese Docência
6
7
8
FI 1.3
9
Number Of Publications
10
11
FI 0.5
12
FI 2.3
13
37
NOVO
TITULO ARTIGO
14
COGNITIVE OUTCOMES FOLLOWING
CARDIOPULMONARY BY PASS
S.A. Malheiros, Massaro A.R., Buffolo E
JAMA 1992; 287: 3077-8
FI 4.4
15
16
51
NOVO
TITULO ARTIGO
FI 3.6
17
Human cytokine responses to coronary artery
bypass grafting with and without
cardiopulmonary bypass
E. Buffolo,
Ann Thorac Surg. 1999 Oct;68(4):1330-5.
Invited Commentary
FI 3.6
18
FI 1.0
AmericanJournalofGeriatricCardiology, 1997; vol.6 No 1
19
BLOOD TRANSFUSION
7
ON PUP
6
6.2
OFF-PUMP
UNITS
5
4
3
3.2
2
1.9
1
1.2
0
< 70 Y
> 70 Y
Vieira et al., Anais 25º Congresso Brasileiro Hematologia e Hemoterapia 2002
20
21
RESULTS: There were no demographic differences between groups. The outcome variables
showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary
bypass group and 3.8% in the off-pump group. Postoperative complications were statistically
different (cardiopulmonary bypass versus off-pump): total length of hospital stay (days)—11.3
vs. 7.2, length of ICU stay (days)—3.7 vs. 2.1, pulmonary complications—10.7% vs. 2.8%,
intubation time (hours)—22 vs. 10, postoperative bleeding (mL)—654 vs. 440, acute renal
failure—8.9% vs. 1.9% and left-ventricle ejection fraction before discharge—22% vs. 29%.
CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass in selected
patients with severe left ventricular dysfunction is valid and safe and promotes less mortality
and morbidity compared with conventional operations.
22
FI 3.6
23
GENDER
AGES
3.528 (73.1%)
12 - 93 years
= 64 + 14
X
1.303 (26.9%)
Applicability 4.831/16.828 (29%)
September - 1981
May - 2015
24
Hospital Mortality
September 1981 – May 2015
CAUSES
Myocardial Infarction
Low Cardiac Output
Pulmonary Insufficiency
Septicemia
Sudden Death
Renal Insufficiency
Refractory Arrhythmias
CVA
Hemorrhage
Pulmonary Embolism
Aortic Dissection
Rupture AAA
Mesenteric Thrombosis
Perforation Gastric Ulcer
16
14
8
8
8
7
6
5
5
5
2
2
1
1
88
(1.8%)
25
MORBIDITY AND MAJOR ADVERSE EVENTS
PROSPECTIVE STUDY ON X OFF-PUMP CABG
ON-PUMP
%
509 patients
OFF-PUMP
%
200 patients
%
TOTAL
709
PROLONGED VENTILATORY SUPPORT
32 (6.3%)
6 (3.0%)
38
PERIOPERATIVE MI
18 (3.5%)
2 (1.0%)
20
VASOPLEGIC SYNDROME
10 (1.9%)
2 (1.0%)
12
SEVERE ARRHYTMIAS
27 (5.3%)
5 (2.5%)
32
BLEEDING (EXCESSIVE)
16 (3.1%)
3 (0.6%)
19
ACUTE RENAL FAILURE
8 (1.6%)
0 (0.0%)
8
BRONCOPNEUMONIA
8 (1.6%)
3 (0.6%)
11
GASTROINTESTINAL HEMORRHAGE
9 (1.8%)
0 (0.0%)
9
CVA
3 (0.6%)
0 (0.0%)
3
131
(25.7%)
21
(10.5%)
152
(14.3%)
Grandini, M. Tese Mestrado, 1997
CONCLUSIONS
26
27
Thank You