Vasconcelos Nair Naiara Barros de, Queiroz Veronica Neves Fialho, Souza Guilherme Martins de, Mangini Sandrigo, Silva Fernando Morita Fernandes, Costa Luiz Guilherme Villares da, Campos Pedro Paulo Zanella do Amaral, Steffen Samuel Padovani, Takaoka Flávio, Serpa Neto Ary, Pereira Adriano José, Barbas Carmen Silvia Valente, Corrêa Thiago Domingos, Chaves Renato Carneiro de Freitas
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Takaoka Anestesia, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2025 May 2;23:eRW1353. doi: 10.31744/einstein_journal/2025RW1353. eCollection 2025.
Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery.
Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death. These complications increase morbidity, mortality, and length of hospital stay. Coronary artery bypass grafting is indicated for patients with significant left main or advanced coronary artery disease. Most patients undergoing coronary artery bypass grafting with a reasonable life expectancy are advised to adopt a multiple-arterial graft strategy using two or three arterial grafts. Revascularization by percutaneous coronary intervention is frequently performed to alleviate symptoms in patients with stable angina and coronary artery stenoses causing moderate or severe ischemia. Intraoperative coagulation management should include tranexamic acid after the induction of anesthesia and protamine immediately after the termination of extracorporeal circulation. The prophylactic use of fresh-frozen plasma, desmopressin, recombinant activated factor VII, or fibrinogen to reduce bleeding is not recommended. Inhaled anesthetics have recognized cardioprotective properties; however, it is unclear whether anesthesia with a volatile agent can reduce mortality in patients undergoing elective surgery. Echocardiography plays an important role in the perioperative management of patients by defining myocardial structure, assessing intracardiac blood flow, aiding preoperative evaluation, facilitating intraoperative monitoring, and providing real-time guidance for intervention. The perioperative management of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, and heart valve surgery is highly complex and involves numerous specific conditions. Effective management requires dedicated multidisciplinary teams skilled in timely recognition, prevention, and treatment to ensure appropriate care.
冠状动脉旁路移植术、经皮冠状动脉介入血管重建术和心脏瓣膜手术是治疗各种心血管疾病患者的关键治疗手段。本文献综述的目的是介绍冠状动脉旁路移植术和心脏瓣膜手术患者围手术期管理的主要证据和实际情况。
尽管手术和麻醉技术有所进步，但冠状动脉旁路移植术和心脏瓣膜手术仍存在围手术期并发症和死亡的重大风险。这些并发症会增加发病率、死亡率和住院时间。冠状动脉旁路移植术适用于患有严重左主干或晚期冠状动脉疾病的患者。大多数预期寿命合理的冠状动脉旁路移植术患者建议采用使用两根或三根动脉移植物的多动脉移植物策略。经皮冠状动脉介入血管重建术常用于缓解稳定型心绞痛和导致中度或重度缺血的冠状动脉狭窄患者的症状。术中凝血管理应包括麻醉诱导后使用氨甲环酸以及体外循环结束后立即使用鱼精蛋白。不建议预防性使用新鲜冰冻血浆、去氨加压素、重组活化因子VII或纤维蛋白原以减少出血。吸入麻醉药具有公认的心脏保护特性；然而，尚不清楚挥发性麻醉剂麻醉是否能降低择期手术患者的死亡率。超声心动图通过定义心肌结构、评估心内血流、辅助术前评估、促进术中监测以及为干预提供实时指导，在患者围手术期管理中发挥重要作用。冠状动脉旁路移植术、经皮冠状动脉介入术和心脏瓣膜手术患者的围手术期管理非常复杂，涉及众多具体情况。有效的管理需要专业的多学科团队，他们具备及时识别、预防和治疗的技能，以确保提供适当的护理。
