THE myocardial revascularization surgery, in which the bypass, has been held for many years, and its indications and risks are well established. The risks of surgery can be divided into immediate and late and are related to the patient's selection and to the surgical experience of the team.
Therefore, a preoperative evaluation will always be performed by the cardiac and anesthesia surgery team, in order to know the other diseases of the patient and to determine if the benefit of the surgery outweighs the risk, when the surgery will be indicated.
The immediate risks of myocardial revascularization surgery are:
- Immediate mortality, ranging from 1 to 10%, depending on the characteristics of the patient. The main factors associated with a poor outcome are: advanced age, previous surgery, left ventricular dysfunction, emergency surgery, cardiogenic (cardiac) shock, presence of other diseases.
- Acute myocardial infarction;
- Brain vascular accident (stroke);
- Mediastinitis (infection of the mediastinum, where the heart is)
- Low cardiac output syndrome (heart can not provide adequate blood flow to other organs);
- Arrhythmias
- Pulmonary complications: atelectasis (a region of the lung stops working), respiratory failure, increased pulmonary secretion, bronchospasm (wheezing), pneumothorax (air enters between the chest wall and lungs), diaphragmatic paralysis (one lung does not expand) ;
- Kidney failure (the kidneys stop working).
The long-term surgical outcome depends on several factors:
- Extent of coronary disease (degree and quantity of obstructed coronary arteries);
- Outcome of surgery;
- Progression of atherosclerosis (obstruction) in coronary vessels;
- Impact of non-cardiac disease (diabetes, lung disease, kidney failure, etc.).
Myocardial revascularization surgery presents many risks, however it may be the only form of treatment for some patients. Surgery is still the most common and long-lasting method of treatment of complex forms of coronary disease. The cardiac surgery team should indicate and explain to patients the risks and benefits of surgery.
