Síndrome cardiorrenal tipo 4 en paciente revascularizado percutáneamente

Introducción: el síndrome cardiorrenal es una patología dada por la disfunción en la interdependencia de estos órganos por interacciones bidireccionales (agudas o crónicas), los cuales pueden afectar indistintamente la función renal o ventricular. Objetivo: presentar y justificar la enfermedad renal crónica como desencadenante de cuadros congestivos por falla cardiaca de novo. Presentación del caso: se reporta el caso de un paciente masculino de 69 años revascularizado percutáneamente hace tres años con múltiples comorbilidades que ingresa en el contexto de una falla cardiaca de novo, secundaria a su enfermedad renal crónica estadio V de base, en manejo con hemodiálisis y en quien se descartó enfermedad coronaria aguda y miocardiopatía infiltrativa. Se logró estabilizar la injuria renal y cardiaca dando egreso y continuando manejo ambulatorio de sus patologías, al llevar un control adecuado de las mismas con Nefrología y Cardiología. Discusión y conclusión: la enfermedad cardiovascular generada por antecedentes renales tiene una gran repercusión en la función ventricular izquierda, causando hipertrofia, lo que lleva a una congestión con posterior sobrecarga debido a la caída del filtrado glomerular y que resulta en la disminución de la fracción de eyección. La enfermedad renal crónica predispone a alteraciones en la función cardiaca, lo que aumenta el riesgo cardiovascular.

Background: Cardiorenal syndrome is a pathology caused by dysfunction in the interdependence of these organs due to bidirectional interactions (acute or chronic), which can affect either renal or ventricular function. Purpose: To present and justify chronic kidney disease as a trigger of congestive conditions due to de novo heart failure. Case presentation: We report the case of a 69-year-old male patient percutaneously revascularized 3 years ago with multiple comorbidities who was admitted in the context of de novo heart failure secondary to his stage V chronic kidney disease on hemodialysis, in whom acute coronary artery disease and infiltrative cardiomyopathy were ruled out. The renal and cardiac injury was stabilized and the patient was discharged and continued outpatient management of his pathologies with adequate control of the same with nephrology and cardiology. Discussion and conclusion: Cardiovascular disease generated by renal history has great repercussion in left ventricular function causing hypertrophy that leads to congestion with subsequent overload due to the fall of glomerular filtration resulting in a decrease of the ejection fraction. Chronic kidney disease predisposes to alterations in cardiac function increasing cardiovascular risk.

Cirugía coronaria sin circulación extracorpórea

La cirugía de revascularización coronaria (CABG) es el estándar de tratamiento para la revascularización de la enfermedad de la arteria coronaria izquierda y/o de tres vasos. La cirugía coronaria sin bomba (OPCAB) evita el uso de derivación cardiopulmonar y puede mejorar los resultados a largo plazo al reducir las tasas de lesión miocárdica perioperatoria, accidente cerebrovascular (ACV), deterioro neurocognitivo y mortalidad de causa cardiaca. En la actualidad, se han llevado a cabo diversos ensayos clínicos desde la popularización del OPCAB en la década de los 90. Sin embargo, hasta el momento no se ha demostrado ningún beneficio del OPCAB en comparación con la cirugía tradicional a pesar de las reducciones favorables a corto plazo en los requerimientos de transfusión y otras complicaciones postoperatorias. Además, OPCAB se asocia con una revascularización miocárdica menos eficaz y no previene por completo las complicaciones tradicionalmente asociadas con la circulación extracorpórea (CEC). Este artículo revisa la evidencia actual de OPCAB en comparación con CABG tradicional en cuanto a los resultados clínicos a corto y largo plazo. Se analizan los resultados de la cirugía coronaria sin circulación extracorpórea (CEC) , comparándola con la cirugía convencional (con CEC). La revascularización coronaria sin CEC presenta resultados similares a la convencional, siempre que se cumplan determinadas condiciones en la selección de los pacientes. Una de ellas, muy importante, es la mayor experiencia del cirujano con el procedimiento.

The results of coronary artery revascularization performed without extracorporeal circulation (off pump) are compared to those of the traditional ("on pump") procedure. Compliance with selective conditions are required to obtain similar results. The most important being the experience of the surgeon performing the off pump procedure.

Estudio de caso: revascularización de paciente con enfoque en el proceso de atención de enfermería / Case study: Patient revascularization with focus on the nursing care process

Introducción: la cardiopatía isquémica fue la primera causa de muerte en México en el año 2020. Su prevalencia aumenta con la edad y es superior en los hombres que en las mujeres; se presenta mayormente en forma de infarto en edades entre 45 y 94 años. Objetivo: describir el caso de un paciente sometido a revascularización aorto-coronaria por cardiopatía isquémica con enfoque del proceso de atención de enfermería (PAE). Metodología: estudio de caso observacional y descriptivo con aplicación del PAE en el perioperatorio de un hombre de 50 años con cardiopatía isquémica crónica, enfermedad multivascular e hipertensión sistémica controlada de 6 años desde que inició, en un hospital público de tercer nivel en Mérida, Yucatán, México. Resultados: se demostró que si se aplica el PAE hay menor riesgo de shock hipovolémico ocasionado por sangrado activo y disminución de riesgo de infección del sitio de herida quirúrgica, evidenciado por el procedimiento quirúrgico extenso. Conclusiones: la metodología del PAE como método científico facilita innovaciones dentro de los cuidados enfermeros, además de las diferentes alternativas en las acciones a seguir para el tratamiento del paciente quirúrgico cardiovascular. También proporciona un método informativo para la atención de cuidados, desarrolla una autonomía para la enfermería y fomenta la consideración como profesional de salud.

Introduction: Ischemic heart disease was the leading cause of death in Mexico in 2020. Its prevalence increases with age and it is higher in men than in women; it is presented mostly as a heart attack between the ages of 45 and 94 years. Objective: To describe the case of a patient undergoing aorto-coronary revascularization for ischemic heart disease with a nursing care process (NCP) approach. Methodology: Observational and descriptive case study with application of NCP in the perioperative period of a 50-year-old man with chronic ischemic heart disease, multivessel disease and controlled systemic hypertension of 6 years since its onset, in a third level public hospital in Merida, Yucatan, Mexico. Results: It was demonstrated that by applying NCP there is a lower risk of hypovolemic shock caused by active bleeding and decreased risk of surgical wound site infection, evidenced by the extensive surgical procedure. Conclusions: The NCP methodology as a scientific method facilitates innovations within nursing care, in addition to the different alternatives in the actions to follow for the treatment of the cardiovascular surgical patient. It also provides an informative method for care, develops autonomy for nursing and promotes consideration as a health professional.

Resultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte / Immediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the São Paulo State: Cross Cohort Study

Resumo Fundamento Os resultados a curto prazo após o uso de enxertos arteriais ainda suscitam questionamentos e dúvidas na sociedade médica. Objetivo Comparar os resultados imediatos de pacientes submetidos à cirurgia de revascularização do miocárdio com enxerto arterial único versus enxertos arteriais múltiplos. Métodos Estudo de coorte transversal no Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). Os dados perioperatórios de 3122 pacientes foram agrupados pelo número de enxertos arteriais utilizados e seus desfechos foram comparados: reoperação, infecção profunda da ferida torácica (IPFT), acidente vascular cerebral, lesão renal aguda, intubação prolongada (>24 horas), tempo de internação curta (<6 dias), tempo de internação prolongada (>14 dias), morbidade e mortalidade. O Propensity Score Matching (PSM) correspondeu a 1062 pacientes, ajustado para o risco de mortalidade. Resultados Após PSM, o grupo enxerto arterial único apresentou pacientes com idade avançada, mais ex-fumantes, hipertensos, diabéticos, portadores de angina estável e infarto do miocárdio prévio. Nos enxertos arteriais múltiplos houve predomínio do sexo masculino, pneumonia recente e cirurgias de urgência. Após o procedimento, houve maior incidência de derrame pleural (p=0,042), pneumonia (p=0,01), reintubação (p=0,006), IPFT (p=0,007) e desbridamento esternal (p=0,015) no grupo de enxertos multiarteriais, porém, menor necessidade de hemotransfusão (p=0,005), infecções de extremidades (p=0,002) e menor tempo de internação (p=0,036). O uso bilateral da artéria torácica interna não foi relacionado ao aumento da taxa de IPFT, e sim a hemoglobina glicosilada >6,40% (p=0,048). Conclusão Pacientes submetidos a técnica multiarterial apresentaram maior incidência de complicações pulmonares e IPFT, sendo que a hemoglobina glicosilada ≥6,40% teve maior influência no resultado infeccioso do que a escolha dos enxertos.

Abstract Background The short-term results after using arterial grafts still raise questions and doubts for medical society. Objective To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery. Methods Cross-sectional cohort study in the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk. Results After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048). Conclusion Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin ≥6.40%, had a greater influence on the infectious outcome than the choice of grafts.

Analysis of revascularization strategies for elderly patients with ST-segment elevation myocardial infarction and multivessel disease / 中华老年医学杂志

Objective:To compare the effects of staged percutaneous coronary intervention(PCI)after emergency PCI and emergency culprit-only PCI on clinical outcomes of elderly patients with ST-segment elevation myocardial infarction(STEMI)and multivessel disease.Methods:A retrospective analysis was performed on 389 elderly patients with STEMI and multivessel lesions, aged ≥70 years and within 12 h of onset, admitted to the Clinical College of Thoracic Medicine, Tianjin Medical University, between January 2014 and September 2019.According to different revascularization strategies, enrolled patients were divided into the culprit-only PCI group(79.18%, 308)and the staged PCI group(20.82%, 81). Kaplan-Meier analysis and the Cox proportional hazards regression model were used to compare the incidences of major adverse cardiac and cerebrovascular events(MACCE), all-cause death, cardiac death, recurrent myocardial infarction, stroke and ischemia-driven revascularization between the two groups and to evaluate the effects of different revascularization strategies on MACCE and all-cause death.Then subgroup analysis was performed.Results:During a 56-month follow-up, 131 patients developed MACCE and 96 patients died.Compared with the culprit-only PCI group, the staged PCI group had a lower risk of MACCE( HR: 0.404, 95% CI: 0.227-0.716, P=0.002), all-cause death( HR: 0.354, 95% CI: 0.171-0.730, P=0.005), cardiac death( HR: 0.363, 95% CI: 0.157-0.838, P=0.018), and recurrent myocardial infarction( HR: 0.229, 95% CI: 0.055-0.953, P=0.043). There was no significant difference in the incidence of stroke or ischemia-driven revascularization between the two groups( P>0.05). The reduced risk with staged PCI for MACCE and for all-cause mortality persisted in all subgroups.Multivariate Cox proportional hazards regression revealed that, after adjusting for confounding factors, staged PCI was an independent protective factor for MACCE( HR: 0.44, 95% CI: 0.239-0.815, P=0.009)and for all-cause death( HR: 0.390, 95% CI: 0.90, P=0.020). Conclusion:Compared with culprit-only PCI, staged PCI can significantly improve the long-term prognosis of elderly patients ≥70 years with STEMI and multivessel disease within 12 h of onset.

Chronic Coronary Syndrome: Medical Therapy or Myocardial Revascularization?

Abstract The best therapeutic strategy for chronic coronary syndrome (CCS) is still controversial. The lack of contemporaneity of medical treatment in many randomized clinical trials prior to the large-scale use of statins, antiplatelet agents, anti-diabetic drugs with cardiovascular protection, and changes in life habits with well-established goals limits the applicability of such studies in current clinical practice. Medical treatment is the only therapeutic option capable of reducing atherosclerotic damage and, therefore, of acting effectively in preventing the progression of this disease. The purpose of this brief review is to critically analyze the main contemporary studies that confront medical treatment with myocardial revascularization in CCS.

Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training.

Protótipo de aplicativo para a educação do paciente antes da revascularização miocárdica / Application prototype for patient education before coronary artery bypass graft surgery / Application prototype for patient education before coronary artery bypass graft surgery / Prototipo de aplicación para la educación de pacientes antes de la revascularización miocárdica

Resumo Objetivo Analisar o conteúdo e usabilidade de um protótipo de aplicativo móvel para apoiar a educação do paciente no pré-operatório de revascularização miocárdica. Métodos Estudo metodológico, quantitativo, baseado no referencial design instrucional contextualizado. Na etapa de análise realizou-se revisão de escopo e um estudo qualitativo com 13 pacientes com a finalidade de identificar o conteúdo para compor o aplicativo. Na etapa de design e desenvolvimento estruturou-se o conteúdo. Durante a implementação, procedeu-se a configuração dos recursos e, na avaliação, utilizou-se a técnica Delphi, com a avaliação do conteúdo a partir dos critérios de Pasquali e a usabilidade do aplicativo por meio do ERGOLIST por 20 juízes na primeira rodada e 16 na segunda. Usou-se, para análise, o coeficiente de validade de conteúdo, considerado válido acima de 0,8 e o percentual de concordância igual ou superior a 80%. Realizou-se o teste binomial em cada item para determinar o nível de significância (p<0,05). Resultados A análise do conteúdo resultou em um coeficiente de validade de conteúdo superior a 0,8 e percentual de concordância superior a 80% em todos os critérios analisados. Já a usabilidade, apresentou percentual superior a 90% em todos os itens. Todos os itens analisados apresentaram significância estatística. O aplicativo OrientaRVM foi composto por 90 telas que formam o menu inicial e nove seções: entenda mais sobre o coração; entenda a sua doença; entenda a cirurgia de ponte de safena ou ponte mamária; cuidados antes da cirurgia; cuidados após a cirurgia; reabilitação e mudanças no estilo de vida; registros do paciente; agenda; quiz. Conclusão O OrientaRVM apresenta conteúdo confiável, funcionalidade adequada e foi recomendado para ser utilizado como recurso auxiliar na educação do paciente antes da revascularização miocárdica.

Resumen Objetivo Analizar el contenido y la usabilidad de un prototipo de aplicación móvil para apoyar la educación de pacientes en el preoperatorio de revascularización miocárdica. Métodos Estudio metodológico, cuantitativo, basado en el marco referencial de diseño instruccional contextualizado. En la etapa de análisis se realizó la revisión de alcance y un estudio cualitativo con 13 pacientes con la finalidad de identificar el contenido para componer la aplicación. En la etapa de diseño y desarrollo se estructuró el contenido. Durante la implementación se realizó la configuración de los recursos y, en la evaluación, se utilizó el método Delphi, con la evaluación del contenido a partir de los criterios de Pasquali y la usabilidad de la aplicación por medio de ERGOLIST por 20 jueces en la primera ronda y 16 en la segunda. Para el análisis se usó el coeficiente de validez de contenido, considerado válido superior a 0,8 y el porcentaje de concordancia igual o superior al 80 %. Se realizó la prueba binominal en cada ítem para determinar el nivel de significación (p<0,05). Resultados El análisis del contenido dio como resultado un coeficiente de validez de contenido superior a 0,8 y porcentaje de concordancia superior al 80 % en todos los criterios analizados. Por otro lado, la usabilidad presentó un porcentaje superior al 90 % en todos los ítems. Todos los ítems analizados presentaron significación estadística. La aplicación OrientaRVM estuvo compuesta por 90 pantallas que forman el menú inicial y nueve secciones: entienda más sobre el corazón; entienda su enfermedad; entienda la cirugía de bypass coronario o puente mamario; cuidados antes de la cirugía; cuidados después de la cirugía; rehabilitación y cambios en el estilo de vida; registros del paciente; agenda; quiz. Conclusión OrientaRVM presenta contenido confiable, funcionalidad adecuada y fue recomendado para su uso como recurso auxiliar en la educación del paciente antes de la revascularización miocárdica.

Abstract Objective To analyze the content and usability of a mobile application prototype to support patient education in the preoperative period of myocardial revascularization. Methods This is a quantitative methodological study based on the contextualized instructional design framework. In the analysis stage, a scoping review and a qualitative study were carried out with 13 patients to identify the content to compose the application. In the design and development stage, content was structured. In the implementation stage, resources were configured. In the assessment stage, the Delphi technique was used, with content assessment from the Pasquali criteria and application usability through the ERGOLIST by 20 judges in the first round and 16 in the second. For analysis, the Content Validity Coefficient was used, considered valid above 0.8 and the percentage of agreement equal to or greater than 80%. The binomial test was performed on each item to determine the significance level (p<0.05). Results Content analysis resulted in a Content Validity Coefficient greater than 0.8 and a percentage of agreement greater than 80% in all analyzed criteria. Usability, on the other hand, presented a percentage greater than 90% in all items. All items analyzed were statistically significant. The OrientaRVM application was composed of 90 screens that form the initial menu and nine sections: understand more about the heart; understand your illness; understand coronary artery bypass graft surgery or breast bypass surgery; care before surgery; care after surgery; rehabilitation and lifestyle changes; patient records; schedule; quiz. Conclusion OrientaRVM presents reliable content, adequate functionality and was recommended to be used as an auxiliary resource in patient education before myocardial revascularization.

Prevalence of Surgical Myocardial Revascularization in Diabetics and Non-diabetics After Acute Myocardial Infarction

Abstract Background Diabetes mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia. The main cause of death among diabetics is cardiovascular disease (CVD), which is a precursor to acute myocardial infarction (AMI). Approximately 30% of diabetic patients with AMI require myocardial revascularization surgery (MRS). Objective To evaluate the prevalence of MRS in diabetic and non-diabetic patients after AMI in a hospital in the city Criciúma, Brazil, during the period from 2016 to 2019. Methods A cross-sectional study was carried out with secondary data collection, with analysis of 215 medical records of diabetic and non-diabetic patients with AMI, submitted or not to MRS during the study period. For statistical analysis, the Shapiro-Wilk test, Pearson's chi-square test and Fisher's exact test were used, with a significance level of α = 0.05. Results The frequency of diabetic AMI patients with hypertension (88.1%) was significantly higher (p<0.01) than of diabetic AMI patients without hypertension. Although no statistically significant differences were found in the other variables between the groups, smoking, hypertension and dyslipidemia were more prevalent in diabetic than in non-diabetic patients with AMI undergoing MRS. Conclusion The prevalence of MRS after AMI in diabetic patients was higher than in non-diabetic patients.

Comparação de Soluções Cardioplégicas em Cirurgia de Revascularização Miocárdica sobre Mecanismos de Autofagia e Apoptose / Comparison of Cardioplegic Solutions in Coronary Bypass Surgery Over Autophagy and Apoptosis Mechanisms

Resumo Fundamento A doença arterial coronariana (DAC) devido à isquemia miocárdica causa perda permanente de tecido cardíaco. Objetivos Nosso objetivo foi demonstrar o possível dano ao miocárdio em nível molecular através dos mecanismos de autofagia e apoptose em pacientes submetidos à cirurgia de revascularização miocárdica. Métodos Um grupo recebeu uma solução de cardioplegia Custodiol e o outro grupo uma solução de cardioplegia sanguínea. Duas amostras miocárdicas foram coletadas de cada paciente durante a operação, imediatamente antes da parada cardíaca e após a liberação do pinçamento aórtico. Foram avaliadas as expressões de marcadores de autofagia e apoptose. O nível de significância estatística adotado foi de 5%. Resultados A expressão do gene BECLIN foi significativa nos tecidos miocárdicos do grupo CS (p=0,0078). Os níveis de expressão dos genes CASPASE 3, 8 e 9 foram significativamente menores no grupo CC. Os níveis pós-operatórios de TnT foram significativamente diferentes entre os grupos (p=0,0072). As expressões dos genes CASPASE 8 e CASPASE 9 foram semelhantes antes e depois do pinçamento aórtico (p=0,8552, p=0,8891). No grupo CC, os níveis de expressão gênica de CASPASE 3, CASPASE 8 e CASPASE 9 não foram significativamente diferentes em amostras de tecido coletadas após pinçamento aórtico (p=0,7354, p=0,0758, p=0,4128, respectivamente). Conclusões Com nossos achados, acreditamos que as soluções CC e CS não apresentam diferença significativa em termos de proteção miocárdica durante as operações de by-pass.

Abstract Background Coronary artery disease (CAD) due to myocardial ischemia causes permanent loss of heart tissue. Objectives We aimed to demonstrate the possible damage to the myocardium at the molecular level through the mechanisms of autophagy and apoptosis in coronary bypass surgery patients. Methods One group was administered a Custodiol cardioplegia solution, and the other group was administered a Blood cardioplegia solution. Two myocardial samples were collected from each patient during the operation, just before cardiac arrest and after the aortic cross-clamp was released. The expressions of autophagy and apoptosis markers were evaluated. The level of statistical significance adopted was 5%. Results The expression of the BECLIN gene was significant in the myocardial tissues in the BC group (p=0.0078). CASPASE 3, 8, and 9 gene expression levels were significantly lower in the CC group. Postoperative TnT levels were significantly different between the groups (p=0.0072). CASPASE 8 and CASPASE 9 gene expressions were similar before and after aortic cross-clamping (p=0.8552, p=0.8891). In the CC group, CASPASE 3, CASPASE 8, and CASPASE 9 gene expression levels were not found to be significantly different in tissue samples taken after aortic cross-clamping (p=0.7354, p=0.0758, p=0.4128, respectively). Conclusions With our findings, we believe that CC and BC solutions do not have a significant difference in terms of myocardial protection during bypass operations.

Effectiveness of Early Mobilization in Prevention and Rehabilitation of Functional Impairment After Myocardial Revascularization Surgery: A Systematic Review

Abstract Introduction Myocardial revascularization surgery is associated with high morbidity and mortality, due to factors like the general anesthesia and the surgical procedure itself. Physiotherapy, combined with early mobilization (EM), can provide the patient with better functional parameters. Objective To review, identify and describe the effectiveness of EM in the prevention and rehabilitation of functional parameters of coronary artery bypass graft surgery. Methodology This is a systematic review conducted between February 2020 and 2021 of randomized clinical trials (RCTs) published in the Cochrane databases Library, LILACS, Scielo and Medline / PubMed. The Physiotherapy Evidence Database (PEDro) scale was used for assessment of the methodological quality of studies included. Results Four studies were reviewed. Two articles assessed functional capacity, one using the cycle ergometer and one with inspiratory muscle training (IMT) together with active exercises and early walking. One article reported a reduction in the incidence of atelectasis and pleural effusion with EM and one article reported improvements in the alveolus-artery gradient and inspiratory muscle power using an inspiratory muscle trainer combined with EM. Conclusion EM is effective in the prevention and rehabilitation of functional parameters after CABG surgery, by improving functional capacity, respiratory muscle power, quality of life and gas exchange, and reducing the incidence of atelectasis and pleural effusion.

Impact of the COVID-19 Outbreak on Coronary Artery Bypass Grafting in Brazil

Abstract Background The COVID-19 pandemic has disrupted the routine of emergency centers around the world, including in Brazil, where the crisis has affected the volume of major cardiac surgeries such as coronary artery bypass grafting. Objective To analyze the impact of the COVID-19 pandemic on the number of surgical procedures for coronary artery bypass grafting in Brazil. Methods An ecological, cross-sectional, quantitative, and descriptive study was conducted. Data for the period from July 2018 to June 2019 and from July 2020 to June 2021 were collected from SIHSUS using DATASUS/Tabwin. Results A global reduction of 26.58% was observed in the analyzed population, with on-pump coronary artery bypass grafting decreasing by 28.10%, and off-pump coronary artery bypass grafting reduced by only 10.31%. Conclusion During the pandemic, there was a 26.58% reduction in the number of surgical procedures for myocardial revascularization in Brazil.

Early Six-Minute Walk Test May Predict Midterm Outcomes Following Coronary Artery Bypass Grafting

ABSTRACT Objective: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6MWD, considering the preoperative baseline as 100%. Methods: A prospective cohort of patients undergoing elective CABG were included. The percentage fall in 6MWD was assessed by the difference between preoperative and postoperative day (POD) five. Clinical outcomes were evaluated three months after hospital discharge. Results: There was a significant decrease in 6MWD on POD5 compared with preoperative baseline values (percentage fall of 32.5±16.5%, P<0.0001). Linear regression analysis showed an independent association of the percentage fall of 6MWD with cardiopulmonary bypass (CPB) and preoperative inspiratory muscle strength. Receiver operating characteristic curve analysis revealed that the best cutoff value of percentage fall in 6MWD to predict poorer clinical outcomes at three months was 34.6% (area under the curve = 0.82, sensitivity = 78.95%, specificity = 76.19%, P=0.0001). Conclusion: This study indicates that a cutoff value of 34.6% in percentage fall of 6MWD on POD5 was able to predict poorer clinical outcomes at three months of follow-up after CABG. Use of CPB and preoperative inspiratory muscle strength were independent predictors of percentage fall of 6MWD in the postoperative period. These findings further support the clinical application of 6MWD and propose an inpatient preventive strategy to guide clinical management over time.

A Surgical Technique to Preserve the Subvalvular Apparatus in Patients Undergoing Mitral Valve Replacement for Severe Ischemic Regurgitation

ABSTRACT Severe functional mitral valve regurgitation should be treated in patients undergoing myocardial revascularization. When replacement is considered the best therapeutic option, preservation of the mitral subvalvular apparatus is crucial, especially in the emergency setting, because of its primary role in preserving geometry and function of left and right ventricles. Here we present a simple and quick technique, where subvalvular apparatus is preserved in toto in patients undergoing mitral valve replacement with a bioprosthesis.