Oxygen saturation and lactate concentration gradient from the right atrium to the pulmonary artery in the immediate postoperative following cardiac surgery with extracorporeal circulation. / Gradiente de saturação de oxigênio e concentração de lactato entre átrio direito e artéria pulmonar no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea.

OBJECTIVE: This prospective study aimed to characterize the changes in blood lactate concentration and blood oxygen saturation in patients during the immediate postoperative period of cardiac surgery with extracorporeal circulation. METHODS: Blood samples were collected from 35 patients in a rapid and random order from the arterial line and from the proximal and distal port of a pulmonary artery catheter. RESULTS: The results showed no statistically significant differences between the blood oxygen saturation in the right atrium (72% ± 0.11%) and the blood oxygen saturation in the pulmonary artery (71% ± 0.08%). The blood lactate concentration in the right atrium was 1.7mmol/L ± 0.5mmol/L, and the blood lactate concentration in the pulmonary artery was 1.6mmol/L ± 0.5mmol/L (p < 0.0005). CONCLUSION: The difference between the blood lactate concentration in the right atrium and the blood lactate concentration in the pulmonary artery might be a consequence of the low blood lactate concentration in the blood from the coronary sinus, as it constitutes an important substrate for the myocardium during this period. The lack of differences between the blood oxygen saturation in the right atrium and the percentage of blood oxygen saturation in the pulmonary artery suggests a lower oxygen extraction by the myocardium given a lower oxygen consumption.

OBJETIVO: Caracterizar as modificações na concentração sanguínea do lactato e da saturação de oxigênio em pacientes no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea. MÉTODOS: Foram coletadas amostras de sangue de 35 pacientes, de forma rápida e aleatória, do acesso arterial e das portas proximal e distal de um cateter pulmonar. RESULTADOS: Não foram verificadas diferenças estatisticamente significantes entre saturação de oxigênio no átrio direito (72% ± 0,11%) e na artéria pulmonar (71% ± 0,08%). A concentração sanguínea de lactato no átrio direito foi de 1,7mmol/L ± 0,5mmol/L, enquanto na artéria pulmonar esta concentração foi de 1,6mmol/L ± 0,5mmol/L (p < 0,0005). CONCLUSÃO: A diferença entre as concentrações sanguíneas de lactato no átrio direito e na artéria pulmonar pode ser consequência da baixa concentração de lactato no sangue do seio coronário, já que o lactato é um importante substrato para o miocárdio durante este período. A ausência de diferenças entre saturação sanguínea de oxigênio no átrio direito e na artéria pulmonar sugere extração de oxigênio mais baixa pelo miocárdio, em razão do menor consumo de oxigênio.

Gradiente de saturação de oxigênio e concentração de lactato entre átrio direito e artéria pulmonar no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea / Oxygen saturation and lactate concentration gradient from the right atrium to the pulmonary artery in the immediate postoperative following cardiac surgery with extracorporeal circulation

RESUMO Objetivo: Caracterizar as modificações na concentração sanguínea do lactato e da saturação de oxigênio em pacientes no pós-operatório imediato de cirurgia cardíaca com circulação extracorpórea. Métodos: Foram coletadas amostras de sangue de 35 pacientes, de forma rápida e aleatória, do acesso arterial e das portas proximal e distal de um cateter pulmonar. Resultados: Não foram verificadas diferenças estatisticamente significantes entre saturação de oxigênio no átrio direito (72% ± 0,11%) e na artéria pulmonar (71% ± 0,08%). A concentração sanguínea de lactato no átrio direito foi de 1,7mmol/L ± 0,5mmol/L, enquanto na artéria pulmonar esta concentração foi de 1,6mmol/L ± 0,5mmol/L (p < 0,0005). Conclusão: A diferença entre as concentrações sanguíneas de lactato no átrio direito e na artéria pulmonar pode ser consequência da baixa concentração de lactato no sangue do seio coronário, já que o lactato é um importante substrato para o miocárdio durante este período. A ausência de diferenças entre saturação sanguínea de oxigênio no átrio direito e na artéria pulmonar sugere extração de oxigênio mais baixa pelo miocárdio, em razão do menor consumo de oxigênio.

ABSTRACT Objective: This prospective study aimed to characterize the changes in blood lactate concentration and blood oxygen saturation in patients during the immediate postoperative period of cardiac surgery with extracorporeal circulation. Methods: Blood samples were collected from 35 patients in a rapid and random order from the arterial line and from the proximal and distal port of a pulmonary artery catheter. Results: The results showed no statistically significant differences between the blood oxygen saturation in the right atrium (72% ± 0.11%) and the blood oxygen saturation in the pulmonary artery (71% ± 0.08%). The blood lactate concentration in the right atrium was 1.7mmol/L ± 0.5mmol/L, and the blood lactate concentration in the pulmonary artery was 1.6mmol/L ± 0.5mmol/L (p < 0.0005). Conclusion: The difference between the blood lactate concentration in the right atrium and the blood lactate concentration in the pulmonary artery might be a consequence of the low blood lactate concentration in the blood from the coronary sinus, as it constitutes an important substrate for the myocardium during this period. The lack of differences between the blood oxygen saturation in the right atrium and the percentage of blood oxygen saturation in the pulmonary artery suggests a lower oxygen extraction by the myocardium given a lower oxygen consumption.

Calidad de vida en pacientes ancianos intervenidos de recambio valvular aórtico: comparación con la población general española / Quality of life en elderly patients undergoing aortic valve replacement: A comparative study with the general Spanish population

Fundamento y objetivo: El objetivo de este estudio es el de comparar la calidad de vida de pacientes ancianos a los que se les ha realizado cirugía de recambio valvular aórtico (RVA) con la de la población general española de la misma edad y del mismo sexo. Pacientes: Se analizó un total de 163 pacientes con una edad igual o superior a 75 años que habían recibido RVA. La calidad de vida se evaluó con el test SF-12 (Short Form Health Survey 12). La mediana del período de seguimiento fue de 37,4 meses. El seguimiento se completó en un 95,6% de los pacientes supervivientes. Los resultados se compararon con los datos publicados para la población general española de la misma edad y del mismo sexo (n=1.312). Resultados: La mortalidad hospitalaria fue del 7,4%. El resultado medio de los componentes sumarios físico y mental fue para las mujeres de 44,69 y de 49,88, y para los varones de 47,38 y de 56,19, respectivamente. Al confrontarlos con la población general española, los pacientes intervenidos mostraron un estado de salud comparable. Conclusiones: Los pacientes ancianos candidatos a RVA representan un grupo de alto riesgo quirúrgico. Sin embargo, la calidad de vida postoperatoria es comparable a la de la población general de la misma edad y del mismo sexo (AU)

Background and objective: The aim of the study was to compare the quality of life of elderly patients undergoing aortic valve replacement with that of a reference group. Patients: A total of 163 patients aged ⩾75 years who underwent aortic valve replacement were analyzed. Quality of life was evaluated by the Short Form Health Survey test 12 (SF-12). The median follow-up period was 37.4 months. Quality of life follow-up was complete at 95.6% of mid-term survivors. Quality of life data was compared with published data of a sample of the Spanish population (n.1312) of the same age and same sex. Results: Overall 30-day mortality was 7.4%. The mean SF-12 physical component score and SF-12 mental component score of the study population were 44,69 and 49,88 for woman and 47,38 and 56,19 for men, respectively. Results: Our sample population showed a post operative quality of live comparable with that of the general population. Conclusions: Elderly patients who are candidates to aortic valve replacement represent a high risk population. Nevertheless, the quality of life achieved post-operatively is comparable with that of the general population (AU)

[Quality of life en elderly patients undergoing aortic valve replacement: a comparative study with the general Spanish population]. / Calidad de vida en pacientes ancianos intervenidos de recambio valvular aórtico: comparación con la población general española.

BACKGROUND AND OBJECTIVE: The aim of the study was to compare the quality of life of elderly patients undergoing aortic valve replacement with that of a reference group. PATIENTS: A total of 163 patients aged 75 years who underwent aortic valve replacement were analyzed. Quality of life was evaluated by the Short Form Health Survey test 12 (SF-12). The median follow-up period was 37.4 months. Quality of life follow-up was complete at 95.6% of mid-term survivors. Quality of life data was compared with published data of a sample of the Spanish population (n.1312) of the same age and same sex. RESULTS: Overall 30-day mortality was 7.4%. The mean SF-12 physical component score and SF-12 mental component score of the study population were 44,69 and 49,88 for woman and 47,38 and 56,19 for men, respectively. Our sample population showed a post operative quality of live comparable with that of the general population. CONCLUSIONS: Elderly patients who are candidates to aortic valve replacement represent a high risk population. Nevertheless, the quality of life achieved post-operatively is comparable with that of the general population.

Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survival.

BACKGROUND AND AIM OF THE STUDY: Since the introduction of its theoretical basis, patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) has been the subject of much debate. The study aim was to compare, by a propensity score adjustment, the survival and quality of life in elderly patients with PPM, to those of a population without mismatch. The analysis was focused on elderly patients, as their high prevalence of calcific aortic stenosis may increase the probability to receive a small-sized aortic prosthesis, and consequently to experience postoperative PPM. METHODS: A total of 163 patients aged > or = 75 years who underwent AVR was analyzed. The median logistic euroSCORE was 7.1%. PPM was considered to be present if the anticipated indexed effective orifice area (IEOA) was < or = 0.85 cm2/m2. The median follow up period was 37.4 months. The patients' quality of life was evaluated using the Short Form 12 (SF-12) Health Survey test. RESULTS: PPM was present in 43% of the patients. In multivariable analysis, patients with PPM were more often female, more often operated on for aortic degenerative calcification, had a larger body surface area, and more often received a bioprosthesis than those without mismatch. The survival analysis did not highlight any significant difference between the two groups. According to a multivariable analysis, the SF-12 physical component score of PPM patients was significantly inferior to that in patients without mismatch (p = 0.001). CONCLUSION: The study results suggest that moderate PPM does not have a negative impact on mid-term mortality in elderly patients after AVR. However, PPM was associated with a reduced quality of life in this elderly population.