Evolution of coronary surgery
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The aging population, coupled with the increasing prevalence of arteriosclerosis and diabetes, causes coronary surgery remains one of the pillars of the current cardiac surgery. The eternal debate about the best option for revascularization of a patient with ischemic heart disease using stents or doing open surgery, maintains a large group of patients with clear indications for each technique. In the intermediate zone it is where decisions are made more complex, because while surgery offers better long-term results, it is also true that it is more aggressive initially for a patient. Pump coronary surgery comes to fill that space to deliver stable results of conventional surgery, with less physiological aggression.
In the 90s the concept of operating beating heart with the technical difficulties that meant rescues. But technological advancement and standardization of methods got this type of surgery is consolidated into pointers hospitals. Added the effect of using arterial grafts for complete revascularization without veins, the results began to gain ground on more traditional techniques. By avoiding side effects of extracorporeal circulation, postoperative patients have less complicated, although the final results in terms of safety are similar.
In this way services have developed Cardiovascular Surgery in which this technique has been incorporated as a standard technique for coronary surgery. The advantage of this is that a high percentage of their patients are made without pump, keeping a small group of conventional surgery for cases unfit. Thus, surgeon training and equipment is optimal for the realization of this technique and precisely the most complex patients will benefit most from these effects.
There is no doubt now that coronary artery surgery done well, both with and without pump, it delivers superior results catheterization / trunk stent disease, diabetes and multivessel. The advantage that a surgical team is familiar with the pump coronary surgery (OPCABG) is that it can also offer lower rate of complications in complex patients.
Usually, the overall strategy is to pump coronary surgery electively, checking in the surgical act itself tolerability of the process and stop the heart in deciding cases with instability. The percentage of off-pump surgery is 85-90%.
