8/7/2019 There is Still Room for Open Cardiovascular Surgery
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NOTAS DE LITERATURA /LITERATURE NOTES
THERE IS STILL ROOM FOR OPEN CARDIOVASCULAR SURGERYAINDA H ESPAO
PARA CIRURGIA CARDIOVASCULAR ABERTA
David Gonalves Nordon*
33
Rev. Fac. Cinc.Md.Sorocaba,v.13,n.1,p. 33, 2011*Acadmicodo
cursode Medicina- FCMS/PUC-SPRecebidoem14/4/2010.Aceitopara
publicaoem15/7/2010.Contato: [email protected]
Despite the constant announcements that opencardiovascular
surgery as a surgical procedure is watching itsdecline, a new study
published in the New England Journal ofMedicine (NEJM) shows that
there is still some room forsuchprocedure.
Thearticle entitled Endovascular versus OpenRepairof Abdominal
Aortic Aneurysm, published online at April11th, 2010, brings us the
continuation of a median 6 year-follow-up study (minimum 5 and
maximum 10 years follow-up) comparing the outcomes of endovascular
repair ofabdominal aortic aneurism, which until then had shown
impressive results in preoperative morbidity and
mortality,andopen repair, whichhadshownmuch
worseoutcomes.Nevertheless, as our eyes were already moving
towards the new minimally invasive procedures, this articlecomes
to changeeven the researchers' expectations. In a long-term
analysis endovascular repair has shown an increase inmortalityat
four or more years of follow-upandno significantdifference when
compared to open repair (rates of death byany cause converged at
two years, and aneurysm-relateddeaths, at six); moreover, the
overall rates of graft-relatedcomplications and reinterventions
were three to four timeshigher in theendovascular repair group
(adjustedhazard ratio
at six months to four years period of time was 7.92
forcomplications and 9.12 for reintervention, thus
representingthemostcomplicatedperiod afterinitial
intervention).
And also, even though analysis has failed to completeevery data
regarding costs, as the researchers did not includeoutpatient
procedures, endovascular repair has shown to bemorecostly
(differenceof $4,568).
In conclusion, to overcome open cardiovascularsurgery at least
regardingaorticaneurism, there is still a lot todevelop in
endovascular procedures. Nonetheless, we can besure that there will
always be more suitable indications for
each type ofprocedure.
BIBLIOGRAPHY
United Kingdom EVAR Trial Investigators, GreenhalghRM, Brown LC,
Powell JT, Thompson SG, Epstein D,Sculpher
MJ.Endovascularversusopen repairof abdominalaorticaneurysm.N Engl J
Med.2010;362(20):1863-71.
Gianini RJ. Ensaio clnico randomizado: verdadeiro ou falso?. Rev
Fac Cinc MdSorocaba. 2010; 12(4):27-31.
Pgina Linha Coluna Onde se l Leia-se:31 Quadro 3 Legenda
*p=1-(1-0,05)x *p=1-(1-0,05)x29 Figura 2 - - a figura abaixo:
Errata
