AVANCES DEL DR. FEDERICO BENETTI
El Dr. Benetti ha realizado numerosos inventos que han permitido el desarrollo y la aplicación de la cirugía coronaria mini invasiva (Cirugía sin Circulación Extracorpórea), técnica que siendo desarrollada por él mismo en la Argentina desde 1978 ha permitido la reproducción de la cirugía en el mundo entero.
Actualmente, cerca del 45 % de la cirugía coronaria en Asia se realiza con esta técnica, 30 % en USA, 18 % en Europa y el 10% en América Latina. Por la ventajas se prevé un incremento mucho mayor en todo el mundo en los próximos años. El Dr. Benetti y su Fundación realizan una ardua labor a nivel mundial en la capacitación y enseñanza de esta y otras técnica a cirujanos del mundo entero.
Cabe destacar que la Fundación Benetti nunca recibió ningún aporte del estado Argentino.
Método de bypass coronario
Método quirúrgico para estabilizar el corazón latiendo durante un bypass
Plataforma de acceso para disección de mamaria interna
Dispositivo quirúrgico para sostener el tejido cardíaco
Cyberheart
MiniOpcab
Stem cells más cirugia coronaria MiniInvasiva
MATERIAL ADICIONAL
Randomized Trial of Bilateral versus Single Internal-Thoracic-Artery Grafts.
Taggart DP1, Altman DG1, Gray AM1, Lees B1, Gerry S1, Benedetto U1, Flather M1; ART Investigators.
Abstract
Background The use of bilateral internal thoracic (mammary) arteries for coronary-artery bypass grafting (CABG) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts. Methods We randomly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. Interim analyses were prespecified at 5 years of follow-up. Results A total of 3102 patients were enrolled; 1554 were randomly assigned to undergo single internal-thoracic-artery grafting (the single-graft group) and 1548 to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group). At 5 years of follow-up, the rate of death was 8.7% in the bilateral-graft group and 8.4% in the single-graft group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.32; P=0.77), and the rate of the composite of death from any cause, myocardial infarction, or stroke was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to 1.17; P=0.69). The rate of sternal wound complication was 3.5% in the bilateral-graft group versus 1.9% in the single-graft group (P=0.005), and the rate of sternal reconstruction was 1.9% versus 0.6% (P=0.002). Conclusions Among patients undergoing CABG, there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up. There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting. Ten-year follow-up is ongoing. (Funded by the British Heart Foundation and others; ART Current Controlled Trials number, ISRCTN46552265.
Risk of stroke with "no-touch" - As compared to conventional off-pump coronary artery bypass grafting. An updated meta-analysis of observational studies.
Kowalewski M1, Suwalski P2, Pawliszak W3, Benetti F4, Raffa GM5, Malvindi PG6, Carrel T7, Paparella D8, Anisimowicz L3.
Conclusion
In patients with multivessel coronary disease, coronary artery bypass grafting (CABG) leads to an unequivocal reduction in long-term mortality, myocardial infarctions and need of repeat revascularization when compared with percutaneous coronary intervention (PCI). Previous randomized trial [1] and meta-analysis [2] pointed to that benefit being offset by excess of early and mid-term cerebral strokes following CABG which are associated with increased morbidity and mortality. Off-pump CABG (OPCAB) - as a strong alternative to CABG performed under extracorporeal circulation, was shown to reduce some of the complications associated with cardiopulmonary bypass, and in particular adverse cerebrovascular events
J Am Coll Cardiol. 2017 Feb 28;69(8):924-936. doi: 10.1016/j.jacc.2016.11.071.
Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta: A Network Meta-Analysis.
Zhao DF1, Edelman JJ2, Seco M2, Bannon PG3, Wilson MK4, Byrom MJ3, Thourani V5, Lamy A6, Taggart DP7, Puskas JD8, Vallely MP
Conclusion
Avoidance of aortic manipulation in anOPCABG may decrease the risk of post-operative stroke, especially in patients with higher stroke risk. In addition, the elimination of cardiopulmonary bypass may reduce the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay.
Grischa Hoffmann et al Short- and long-term follow-up after minimally invasive direct coronary artery bypass in octogenarios Grischa Hoffmann Interact CardioVasc Thorac Surg (2016) 23 (3): 377-382.
Conclusion
MIDCAB represents a safe treatment option in octogenarians and is associated with a good perioperative outcome and satisfying long-term results in octogenarians.
N Engl J Med. 2016 Dec 29;375(26):2540-9. doi: 10.1056/NEJMoa1610021. Epub 2016 Nov 14.
No-Touch Saphenous Vein Harvesting May Improve Further the Patency of Saphenous Vein Composite Grafts: Early Outcomes and 1-Year Angiographic Results.
Kim YH1, Oh HC1, Choi JW1, Hwang HY1, Kim KB2.
Conclusion
The SV grafts harvested with a no-touch technique further improved the early and 1-year patency of SV composite grafts. Midterm and long-term angiographic follow-up may be warranted to demonstrate the superiority of no-touch SV composite grafts.
A Thorac Surg. 2016 Dec 1. pii: S0003-4975(16)31275-9. doi: 10.1016/j.athoracsur.2016.09.024. [Epub ahead of print]
Todos estos son algunos de los recientes trabajos científicos publicados en peer review. Los mismos son concluyentes en cuanto que el mejor tratamiento actual para los pacientes con obstrucciones coronarias es emplear nuestras técnicas quirúrgicas ya sea con el concepto Híbrido o aisladas para la arteria descendente anterior conectando la arteria mamaria izquierda es decir MIDCAB o MINI OPCAB más stents on sin stents o nuestra técnica de cirugía sin bomba sin tocar la aorta conectando la mamaria izquierda a la arteria descendente anterior y los otros bypasses usando la mamaria derecha como inflow con vena non touch. Al no haberse podido demostrar a 5 años la superioridad al usar 2 arterias mamarias en vez de una hasta el momento. Todos los beneficios con respecto a la cirugía convencional con circulación extracorpórea se ven más a medida que el paciente tiene más comorbilidades y es más añoso. No obstante la demostración de la reducción de 61% de STROKE al no usar la circulación extracorpórea y no tocar la aorta es un dato científico contundente en tratar de abolir la circulación extracorpórea en el paciente que necesite cirugía coronaria de ser posible La cirugía sin la circulación extracorpórea (Técnica que comenzamos a desarrollar en Rosario en 1978 e impusimos en el Mundo entero). Requiere de un entrenamiento adecuado y supervisado por alguien con experiencia hasta su aplicación en forma rutinaria.
ALGUNAS PATENTES INTERNACIONALES
Las patentes obtenidas por el Dr. Federico Benetti por las cuales no cobra ningún tipo de Royalti son:
· Surgical Devices for Imposing a Negative Pressure to Stabilize Cardiac Tissue During Surgery, Patent Number 5,906,607,date of Patent May 25, 1999.
· Method for Coronary Artery Bypass, Patent Number 5,888,247, date of Patent March 30, 1999.
· Method for Coronary Artery Bypass, Patent Number 5,947,125, date of Patent September 7, 1999.
· Surgical Method for Stabilizing the beating heart during coronary artery bypass graft surgery, Patent Number 5,894,843, date of Patent April 20, 1999.
· Surgical Devices for Imposing a Negative Pressure to Fix the position during Surgery, Patent Number 5,727,569, date of Patent March 17, 1998.
· Access platform for Internal Mammary Dissection, Patent Number 5,730,757, date March 24, 1998.
· Xyphoid access for cardiac surgical procedures, Patent Number 6,736,774, date May 18, 2004.