Jatene F B, Ferreira H P, Ramires J A, Oliveira e Silva M, Fróes L B, Siaulys M, de Oliveira S A, Jatene A D
Instituto do Coraçăo do Hospital das Clínicas, FMUSP.
Arq Bras Cardiol. 1990 Feb;54(2):105-9.
To compare the effects of two methods for myocardial preservation during coronary artery by pass graft (CABG): the intermittent aortic cross-clamping (IACC) and the cold hyperkalemic solution (CHS).
One hundred and sixty-three patients operated for CABG between October/83 to May/84 were studied retrospectively. Those operated in emergency situations, reoperations and those who required concomitant additional procedures were excluded. The surgical technique used in both groups was essentially the same. Group I comprised 93 cases (40-70 years-old, median 57.7% y; 86% male) in which IACC were used. Group II comprised 70 cases (37-72 years old, median 67.7 y; 80% male) in which CHS (St. Thomas) was injected into the aortic root. The patients were evaluated in the immediate postoperative period at 3, 6, 12 months and then in variable periods until the 61 months of late follow-up. Myocardial ischemia and infarction, the use of drugs and the hospital time recovery were evaluated. The occurrence of symptoms, return to work, physical capacity, reinternations, reoperations and late deaths were evaluated in the late follow-up.
During hospital period, no death was observed. Perioperative myocardial infarct was similar in both groups (group I = 2.1% and group II = 1.4%) statistical difference in the others parameters was observed. Of 95.5% of the patients who had postoperative observations, 80% had a late follow-up ranged from 30 to 61 months (median 38 months). One patient of each group had a cardiac death. In both groups (group I--1 patient and group II--4 patients) coronary insufficiency symptoms related were present and no statistical difference in the others parameters was observed.
CHS or IACC were efficient and similar methods for myocardial protection in an elective group of patients submitted to a CABG in the immediate and late follow-up.
比较冠状动脉搭桥术（CABG）期间两种心肌保护方法的效果：间歇性主动脉阻断（IACC）和冷高钾溶液（CHS）。
回顾性研究1983年10月至1984年5月期间接受CABG手术的163例患者。排除急诊手术、再次手术以及需要同时进行其他附加手术的患者。两组所采用的手术技术基本相同。第一组包括93例患者（年龄40 - 70岁，中位年龄57.7岁；86%为男性），采用IACC方法。第二组包括70例患者（年龄37 - 72岁，中位年龄67.7岁；80%为男性），将CHS（圣托马斯液）注入主动脉根部。在术后即刻、3个月、6个月、12个月进行评估，然后在不同时间段直至61个月的晚期随访。评估心肌缺血和梗死情况、药物使用情况以及住院恢复时间。在晚期随访中评估症状的发生、恢复工作情况、身体能力、再次住院、再次手术以及晚期死亡情况。
在住院期间，未观察到死亡病例。两组围手术期心肌梗死发生率相似（第一组 = 2.1%，第二组 = 1.4%），其他参数未观察到统计学差异。在进行术后观察的95.5%的患者中，80%进行了30至61个月（中位时间38个月）的晚期随访。每组各有1例患者发生心源性死亡。两组（第一组1例患者，第二组4例患者）均出现与冠状动脉供血不足相关的症状，其他参数未观察到统计学差异。
对于接受CABG的择期手术患者，在近期和远期随访中，CHS或IACC是有效的且相似的心肌保护方法。
