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1.
Rev. Assoc. Med. Bras. (1992) ; 66(12): 1673-1678, Dec. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143654

ABSTRACT

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.


RESUMO OBJETIVO: A fibrilação atrial pós-operatória de início recente (Poaf) é a arritmia mais comum após a cirurgia de revascularização do miocárdio (CABG) e associada a hospitalização prolongada, acidente vascular cerebral e mortalidade. O ângulo QRS-T [f(QRS-T)] do plano frontal, que é definido como o ângulo entre as direções da despolarização ventricular (eixo-QRS) e repolarização (eixo-T), é um novo marcador da heterogeneidade da repolarização ventricular. O ângulo f(QRS-T) está associado a desfechos cardíacos adversos. À luz desses achados, neste estudo, objetivamos investigar a relação potencial entre o ângulo f(QRS-T) e a Poaf. MéTODOS: Cento e oitenta pacientes submetidos a CABG entre agosto de 2017 e setembro de 2018 foram incluídos no estudo retrospectivamente. Dois grupos foram estabelecidos como pacientes com ritmo sinusal pós-operatório (n=130) e com Poaf (n=50). O ângulo f(QRS-T) e todos os dados foram comparados entre os grupos. RESULTADOS: Ângulo f(QRS-T) (p<0,001), escore Syntax (p=0,039), níveis séricos de PCR de alta sensibilidade (p=0,026), idade média (p<0,001), taxa de hipertrofia ventricular esquerda eletrocardiográfica (LVH) (p=0,019) e taxa de hipertensão (p=0,007) foram maiores; a fração de ejeção média do ventrículo esquerdo (LVEF) (p<0,001) foi menor no grupo com Poaf. As análises de regressão logística multivariável demonstraram que menor LVEF (p=0,004), LVH (p=0,041), maior idade (p=0,008) e maior ângulo f(QRS-T) (p<0,001) foram independentemente associados à Poaf. CONCLUSÕES: Níveis de ângulo altos f(QRS-T) estão intimamente associados à Poaf. O ângulo f(QRS-T) pode ser um indicador potencial de Poaf.


Subject(s)
Humans , Atrial Fibrillation/etiology , Postoperative Complications/etiology , Stroke Volume , Coronary Artery Bypass/adverse effects , Retrospective Studies , Risk Factors , Ventricular Function, Left
2.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1473-1475, Nov. 2020.
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143643

ABSTRACT

SUMMARY Atrial fibrillation (AF) is the most common arrhythmia in the postoperative period of cardiac surgery, with a prevalence between 15-40% after coronary artery bypass surgery (CABG). Several strategies have been tested for the prevention and management of AF postoperatively. Previous studies and analysis of records have shown higher rates of hospitalization and clinical outcomes associated with this entity, including increased mortality in the short- and long-term. This perspective reviews the topic, and offers recommendations for the management of this arrhythmia in the postoperative period of CABG, with a special focus on anticoagulation strategies.


Subject(s)
Humans , Atrial Fibrillation/etiology , Atrial Fibrillation/epidemiology , Cardiac Surgical Procedures , Postoperative Complications , Postoperative Period , Coronary Artery Bypass/adverse effects
4.
Rev. bras. cir. cardiovasc ; 35(5): 619-625, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137340

ABSTRACT

Abstract Objective: The aim of this study was to evaluate the value of CHA2DS2-VASc and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk scores for prediction of postoperative atrial fibrillation (AF) development in patients undergoing coronary artery bypass grafting (CABG) operation. Methods: The population of this observational study consisted of 370 patients undergoing CABG operation. CHA2DS2-VASc and ATRIA risk scores were calculated for all patients and their association with postoperative AF (AF episode lasting > 5 min) were evaluated. Predictors of postoperative AF were determined by multiple logistic regression analysis. Results: During follow-up, 110 patients (29.7%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: ATRIA risk score (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.11-1.36; P<0.001), fasting glucose level (OR 1.006; 95% CI 1.004-1.009; P<0.001), and 24-hour drainage amount (OR 1.002; 95% CI; 1.001-1.004; P<0.001). Receiver operating characteristic curve analyses showed that CHA2DS2-VASc and ATRIA risk scores were significant predictors for new-onset AF (C-statistic 0.648; 95% CI 0.59-0.69; P<0.001; and C-statistic 0.664; 95% CI 0.61-0.71; P<0.001, respectively). Conclusion: CHA2DS2-VASc and ATRIA risk scores predict new AF in patients undergoing CABG.


Subject(s)
Humans , Male , Female , Atrial Fibrillation/diagnosis , Atrial Fibrillation/etiology , Coronary Artery Bypass/adverse effects , Stroke , Stroke Volume , Predictive Value of Tests , Risk Factors , Ventricular Function, Left , Risk Assessment
5.
Rev. bras. cir. cardiovasc ; 35(3): 368-374, May-June 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137261

ABSTRACT

Abstract Objective: The current review evaluates recent literature on the different aspects of prophylaxis in postoperative pulmonary and venous thromboembolism and their main risk factors. Methods: The literature survey was carried out based on the PubMed data using the keywords "coronary artery bypass graft" and "venous thromboembolism" as components of the search field title. Results: Studies reported several risk factors for postoperative thromboembolism including advanced age, postoperative immobilization, type of thromboprophylaxis, obesity, and location of the surgery. Conclusion: According to the studies, tailored prophylaxis could be easily adapted to decrease the intensity and duration of postoperative thromboembolism in a patient with several disorders and comorbidities, especially in cardiovascular disease.


Subject(s)
Humans , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Postoperative Complications/prevention & control , Coronary Artery Bypass/adverse effects , Risk Factors , Anticoagulants/therapeutic use
6.
Rev. bras. cir. cardiovasc ; 35(3): 274-284, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137258

ABSTRACT

Abstract Objective: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG). Methods: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint. Results: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE. Conclusion: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease , Percutaneous Coronary Intervention , Lymphocytes , Coronary Artery Bypass/adverse effects , Retrospective Studies , Treatment Outcome , Neutrophils
7.
Rev. bras. cir. cardiovasc ; 35(3): 249-253, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137252

ABSTRACT

Abstract Objective: To compare the incidence of postoperative complications (PC) between diabetic and nondiabetic patients undergoing cardiovascular surgeries (CS). Methods: This is a retrospective cross-sectional study, based on the analysis of 288 medical records. Patients aged ≥ 18 years, admitted to the intensive care unit (ICU) between January 2012 and January 2013, and undergoing coronary artery bypass grafting (CABG) or vascular surgeries were included. The population was divided into those with and without type 2 diabetes mellitus (T2DM), and then it was evaluated the incidence of PC between the groups. Results: The sample included 288 patients, most of them being elderly (67 [60-75] years old) male (64%) subjects. Regarding to surgical procedures, 60.4% of them were undergoing vascular surgeries and 39.6% were in the postoperative period of CABG. The incidence of T2DM in this population was 40% (115), just behind hypertension, with 72% (208). Other risk factors were also observed, such as smoking in 95 (33%) patients, dyslipidemias in 54 (19%) patients, and previous myocardial infarction in 55 (19%) patients. No significant difference in relation to PC (bleeding, atrial fibrillation, cardiorespiratory arrest, and respiratory complications) between the groups was observed (P>0.05). Conclusion: T2DM has a high incidence rate in the population of critically ill patients submitted to CS, especially in the elderly. However, in this small retrospectively analyzed study, there was no significant increase in PC related to diabetes for patients undergoing CS.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Cardiovascular Surgical Procedures/adverse effects , Diabetes Mellitus, Type 2/complications , Coronary Artery Bypass/adverse effects , Cross-Sectional Studies , Retrospective Studies , Risk Factors
8.
Rev. bras. cir. cardiovasc ; 34(6): 739-748, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057500

ABSTRACT

Abstract Introduction: The true influence of the low mean arterial pressure (low MAP) during coronary artery bypass grafting (CABG) on the development of postoperative cognitive deficit (POCD) remains controversial. We aimed to perform a meta-analysis and meta-regression to determine the effect of low MAP on POCD, as well as moderator variables between low MAP and POCD. Methods: The Web of Science, PubMed database, Scopus and the Cochrane Library database (up to June 2018) were searched and retrieved articles systematically reviewed. Only randomized controlled trials (RCTs) comparing maintenance of low MAP (<80 mmHg) and high MAP (>80 mmHg) during cardiopulmonary bypass (CPB) were included in our final review. Statistical analysis of the risk ratio (RR) and corresponding 95% confidence interval (CI) was used to report the overall effect. The overall effect and meta-regression analysis were done using Mantel-Haenszel risk ratio (MHRR) and the corresponding 95% confidence interval (CI). Results: A total of 731 patients in three RCTs were included in this study. POCD occurred in 6.4% of all cases. Maintenance of low MAP did not reduce the occurrence of POCD (MHRR 1.012 [95% CI 0.277-3.688]; Z=0.018; P=0.986; I2=66%). Shorter CPB time reduced the occurrence of POCD regardless of group assignment (MH log risk ratio -0.519 [95% CI -0.949 - -0.089]; Z= -2.367; P=0.017). Conclusion: POCD is a common event among CABG patients. The neuroprotective effect of low MAP on POCD was attenuated by the prolonged CPB time.


Subject(s)
Humans , Male , Female , Postoperative Complications/prevention & control , Coronary Artery Bypass/rehabilitation , Cognition Disorders/prevention & control , Hypotension , Postoperative Complications/etiology , Postoperative Period , Coronary Artery Bypass/adverse effects , Risk Factors , Cognition Disorders/etiology , Extracorporeal Circulation , Arterial Pressure , Neuropsychological Tests
9.
Rev. bras. cir. cardiovasc ; 34(6): 749-758, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057489

ABSTRACT

Abstract Objective: In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. Methods: Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. Results: The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. Conclusion: In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Coronary Artery Disease/etiology , Coronary Artery Bypass/adverse effects , Behcet Syndrome/complications , Postoperative Complications , Prognosis , Behcet Syndrome/surgery , Behcet Syndrome/mortality , Risk Factors , Aneurysm, False/etiology , Coronary Vessels/surgery , Rare Diseases , Preoperative Period
10.
Arq. bras. cardiol ; 113(5): 1002-1005, Nov. 2019. graf
Article in English | LILACS | ID: biblio-1055043

ABSTRACT

Abstract Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery. A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom. In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient's symptoms, surgical compatibility and anatomy of fistula.


Resumo A fístula da artéria mamária interna esquerda (AMIE) para a artéria pulmonar (AP) é raramente encontrada na prática diária. Nos últimos anos, opções de terapia endovascular surgiram para o tratamento de formações de fístula e foram substituídas por cirurgia. Um homem de 53 anos de idade, internado em nosso ambulatório com sintomas de angina típica e falta de ar, apesar da terapia clínica ideal. Em seu histórico relevante, ele teve uma cirurgia de revascularização miocárdica (CRM) em 2009, na qual sua AMIE foi anastomosada à descendente anterior esquerda (DAE) e à artéria ramus sequencialmente. A angiografia coronária, incluindo imagens seletivas da AMIE, demonstrou uma formação de fístula proveniente da porção proximal da AMIE e drenando para AP. Após o fechamento bem-sucedido da fístula com embolização transcateter com mola, o paciente recebeu alta sem qualquer complicação e sintoma. Em conclusão, embora fístula entre AMIE e AP seja uma condição clínica pouco frequente, deve ser considerada como uma causa potencial de angina persistente após a operação de revascularização do miocárdio. As opções de tratamento incluem terapia médica conservadora, ligadura cirúrgica e intervenções endovasculares. A melhor terapia deve ser individualizada para cada paciente em relação aos sintomas do paciente, compatibilidade cirúrgica e anatomia da fístula.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Artery , Catheterization, Peripheral/methods , Arterio-Arterial Fistula/therapy , Embolization, Therapeutic/methods , Angina Pectoris/therapy , Mammary Arteries , Postoperative Complications , Blood Vessel Prosthesis , Coronary Artery Bypass/adverse effects , Arterio-Arterial Fistula/complications , Arterio-Arterial Fistula/etiology , Treatment Outcome , Self Expandable Metallic Stents , Angina Pectoris/etiology
11.
Rev. bras. cir. cardiovasc ; 34(5): 565-571, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042031

ABSTRACT

Abstract Objective: Acute kidney injury (AKI) is one of the most important complications after coronary artery bypass grafting (CABG) procedure. Serum albumin, which is an acute phase reactant, is suggested to be associated with AKI development subsequent to various surgical procedures. In this study, we research the relation between preoperative serum albumin levels and postoperative AKI development in diabetes mellitus (DM) patients undergoing isolated CABG. Methods: We included a total of 634 diabetic patients undergoing CABG (60.5±9.1 years, 65.1% male) into this study, which was performed between September 2009 and January 2014 in a single center. The relation between preoperative serum albumin levels and postoperative AKI development was observed. AKI was evaluated and diagnosed using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. Results: AKI was diagnosed in 230 (36.3%) patients. Multiple logistic regression analysis was performed to determine the independent predictors of AKI development. Proteinuria (odds ratio [OR] and 95% confidence interval [CI], 1.066 [1.002-1.135]; P=0.043) and low preoperative serum albumin levels (OR and 95% CI, 0.453 [0.216-0.947]; P=0.035) were found to be independent predictors of AKI. According to the receiver operating characteristic curve analysis, albumin level <3mg/dL (area under the curve: 0.621 [0.572-0.669], P<0.001) had 83% sensitivity and 10% specificity on predicting the development of AKI. Conclusion: We observed that a preoperative low serum albumin level was associated with postoperative AKI development in patients with DM who underwent isolated CABG procedure. We emphasize that this adjustable albumin level should be considered before the operation since it is an easy and clinically implementable management for the prevention of AKI development.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/adverse effects , Hypoalbuminemia/blood , Diabetes Complications/blood , Acute Kidney Injury/etiology , Acute Kidney Injury/blood , Postoperative Complications/blood , Proteinuria , Reference Values , Time Factors , Blood Glucose/analysis , Body Mass Index , Logistic Models , Retrospective Studies , Risk Factors , Analysis of Variance , Sensitivity and Specificity , Statistics, Nonparametric , Creatinine/blood , Preoperative Period , Acute Kidney Injury/diagnosis
12.
Rev. bras. cir. cardiovasc ; 34(5): 542-549, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042056

ABSTRACT

Abstract Objective: To evaluate the prognostic value of CHA2DS2-VASc score in individuals undergoing isolated coronary artery bypass grafting (CABG) surgery. Methods: Records of consecutive 464 patients who underwent elective isolated CABG, between January 2015 and August 2017, were retrospectively reviewed. A major adverse cardiac event (MACE) was the primary outcome of this study. MACE in patients with low (L) (<2, n: 238) and high (H) (≤2, n: 226) CHA2DS2-VASc scores were compared. Univariate logistic regression analysis identified preditors of MACE. Results: Hypertension, diabetes mellitus, and peripheral vascular disease were more frequent in the H group than in the L group. European System for Cardiac Operative Risk Evaluation (EuroSCORE) I and SYNTAX I scores were similar in both groups while SYNTAX II-CABG score was significantly higher in the H group than in the L group. Postoperative myocardial infarction, need for intra-aortic balloon pump, acute renal failure, and mediastinitis were more frequent in the H group than in the L group. The H group had significantly higher in-hospital mortality and MACE rates than the L group (P<0.01). EuroSCORE I, SYNTAX II-CABG, and CHA2DS2-VASc scores were predictors for MACE. SYNTAX II-CABG > 25.1 had 68.4% sensitivity and 52.7% specificity (area under the curve [AUC]: 0.653, P=0.04, 95% confidence interval [CI]: 0.607-0.696) and CHA2DS2-VASc > 2 had 52.6% sensitivity and 84.1% specificity (AUC: 0.752, P<0.01, 95% CI: 0.710-0.790) to predict MACE. Pairwise comparison of receiver-operating characteristic curves revealed similar accuracy for both scoring systems. Conclusion: CHA2DS2-VASc score may predict MACE in patients undergoing isolated CABG.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/surgery , Coronary Artery Bypass/adverse effects , Risk Assessment/methods , Heart Diseases/diagnosis , Heart Diseases/etiology , Prognosis , Reference Values , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Logistic Models , Coronary Artery Bypass/mortality , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment Outcome , Hospital Mortality , Statistics, Nonparametric , Diabetes Complications , Heart Diseases/mortality , Hypertension/complications
13.
Rev. bras. cir. cardiovasc ; 34(5): 581-587, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042051

ABSTRACT

Abstract Objective: The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). Methods: This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. Results: Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). Conclusion: Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/methods , Carotid Stenosis/diagnostic imaging , Ultrasonography, Doppler, Duplex/methods , Postoperative Complications/etiology , Time Factors , Severity of Illness Index , Logistic Models , Coronary Artery Bypass/adverse effects , Retrospective Studies , Risk Factors , Treatment Outcome , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Carotid Stenosis/etiology , Stroke/etiology , Preoperative Period
14.
Rev. bras. cir. cardiovasc ; 34(5): 588-595, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042049

ABSTRACT

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Polyglactin 910/therapeutic use , Saphenous Vein/surgery , Surgical Wound Infection/prevention & control , Triclosan/therapeutic use , Coronary Artery Bypass/methods , Suture Techniques , Anti-Infective Agents, Local/therapeutic use , Pain, Postoperative/prevention & control , Time Factors , Body Mass Index , Coronary Artery Bypass/adverse effects , Double-Blind Method , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Diabetes Complications
15.
Rev. bras. cir. cardiovasc ; 34(5): 560-564, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042042

ABSTRACT

Abstract Introduction: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. Methods: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. Results: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). Conclusion: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.


Subject(s)
Humans , Male , Female , Middle Aged , Saphenous Vein/transplantation , Coronary Artery Disease/etiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/adverse effects , Atherosclerosis/etiology , Atherosclerosis/diagnostic imaging , Time Factors , Retrospective Studies , Coronary Angiography/methods , Ultrasonography, Interventional/methods , Early Diagnosis
16.
Rev. bras. cir. cardiovasc ; 34(4): 444-450, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020503

ABSTRACT

Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Arrhythmias, Cardiac/etiology , Postoperative Complications/etiology , Coronary Artery Disease/surgery , Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass/adverse effects , Opioid-Related Disorders/complications , Arrhythmias, Cardiac/epidemiology , Postoperative Complications/epidemiology , Blood Pressure , Epinephrine/adverse effects , Central Venous Pressure , Heart Rate , Intensive Care Units
17.
Rev. bras. cir. cardiovasc ; 34(4): 396-405, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020497

ABSTRACT

Abstract Objective: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.


Subject(s)
Humans , Male , Female , Aged , Coronary Artery Bypass/mortality , Myocardial Ischemia/surgery , Stroke/etiology , Percutaneous Coronary Intervention/mortality , Heart Failure/surgery , Postoperative Complications/etiology , Postoperative Complications/mortality , Brazil/epidemiology , Review Literature as Topic , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Coronary Artery Bypass/adverse effects , Epidemiologic Methods , Multicenter Studies as Topic , Treatment Outcome , Practice Guidelines as Topic , Myocardial Ischemia/mortality , Evidence-Based Medicine , Stroke/mortality , Percutaneous Coronary Intervention/adverse effects
18.
Rev. bras. cir. cardiovasc ; 34(3): 297-304, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013476

ABSTRACT

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Saphenous Vein/transplantation , Blood Platelets/physiology , Vascular Patency/physiology , Coronary Artery Bypass/adverse effects , Platelet Count , Reference Values , Saphenous Vein/physiopathology , Coronary Artery Disease/etiology , Echocardiography , Logistic Models , Coronary Artery Bypass/methods , Predictive Value of Tests , Retrospective Studies , Risk Factors , ROC Curve , Age Factors , Coronary Angiography/methods , Treatment Failure , Statistics, Nonparametric , Hematologic Tests
19.
Rev. bras. cir. cardiovasc ; 34(2): 142-148, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-990566

ABSTRACT

Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Registries/statistics & numerical data , Coronary Artery Bypass/methods , Coronary Artery Bypass/statistics & numerical data , Brazil , Coronary Artery Bypass/adverse effects , Cross-Sectional Studies , Treatment Outcome , Hospital Mortality , Intraoperative Complications
20.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 316-318, Mar. 2019.
Article in English | LILACS | ID: biblio-1003030

ABSTRACT

SUMMARY Coronary artery bypass graft (CABG) is a consolidated treatment in patients with coronary artery disease (CAD) for both symptom control and improvement of prognosis. The patency of venous grafts is still the most vulnerable point of the surgical treatment since it presents a high prevalence of occlusion both in the immediate postoperative period and in the long-term follow-up. Aspirin plays a well-established role in this setting, and for a long time, clopidogrel use has been restricted to patients allergic to aspirin. Recently, subgroup analyses of studies with different anti-platelet therapies have shown reduced mortality and cardiovascular events in patients on dual anti-platelet antiplatelet therapy (DAPT) undergoing CABG, although such studies have not been designed to evaluate this patient profile. However, there is still an insufficient number of randomized studies using DAPT in this context, resulting in a disagreement between the European and American cardiology societies guidelines regarding their indication and generating doubts in clinical practice.


RESUMO A cirurgia de revascularização miocárdica (CRM) é tratamento fundamental em pacientes com doença arterial coronariana (DAC) tanto para controle de sintomas quanto para melhora do prognóstico. A patência dos enxertos venosos ainda hoje é o ponto mais vulnerável do tratamento cirúrgico, por apresentar alta prevalência de oclusão tanto no pós-operatório imediato como no seguimento em longo prazo. A aspirina tem papel bem estabelecido neste cenário e, por muito tempo, o uso do clopidogrel ficou restrito a pacientes alérgicos a aspirina. Recentemente, análises de subgrupos de estudos com diferentes terapias antiplaquetárias demonstraram redução de mortalidade e eventos cardiovasculares em pacientes em uso de dupla antiagregação plaquetária (Dapt) submetidos à CRM, ainda que tais estudos não tenham sido desenhados para avaliar este perfil de pacientes. Contudo, há ainda uma quantidade insuficiente de estudos randomizados com uso de Dapt nesse contexto, resultando em uma discordância entre as diretrizes europeia e americana de cardiologia quanto à sua indicação e gerando dúvidas na prática clínica.


Subject(s)
Humans , Vascular Patency/drug effects , Platelet Aggregation Inhibitors/therapeutic use , Coronary Artery Bypass/methods , Graft Occlusion, Vascular/prevention & control , Coronary Artery Disease/surgery , Aspirin/therapeutic use , Coronary Artery Bypass/adverse effects , Treatment Outcome , Clopidogrel/therapeutic use , Ticagrelor/therapeutic use
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