Atrial Fibrillation After Coronary Artery Bypass Grafting and Its Relationship with Hospital Complications in São Paulo State.

INTRODUCTION: Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential. OBJECTIVE: To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting. METHODS: This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software. RESULTS: A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF. CONCLUSION: POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality.

Atrial fibrillation after coronary artery bypass grafting and its relationship with hospital complications in São Paulo state

INTRODUCTION: Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential. OBJECTIVE: To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting. METHODS: This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software. RESULTS: A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF. CONCLUSION: POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality.

Impacto da pandemia por COVID-19 em centro de referência em cirurgia cardiovascular / Impact of the COVID-19 pandemic in a cardiovascular surgery referral center

INTRODUÇÃO: O primeiro caso de infecção causado pela COVID-19 foi primeiramente reportado em Wuhan, China, em meados de dezembro 2019. Desde então, a infecção tomou proporções globais, afetando mais de 200 países. A presença de doença cardiovascular é fator de risco frequentemente observado nos pacientes acometidos pela COVID-19 associado a altas taxas de mortalidade e morbidade. MÉTODOS: Trata-se de um estudo observacional, transversal, retrospectivo, a fim de avaliar o impacto no número de procedimentos cirúrgicos em centro de referência nacional em cirurgia cardiovascular. Foram comparados os números absolutos de cirurgia de revascularização miocárdica, troca ou plastia valvar, correção de aneurismas de aorta, transplante cardíaco e cirurgias para correção de patologias congênitas entre 2019 (Janeiro ­ Dezembro) e 2020 (Janeiro ­ Dezembro). RESULTADOS: Em 2019, foram realizados 1383 procedimentos, dentre os quais, 591 cirurgias de revascularização miocárdica isolada e associadas à aneurismectomia, correção de comunicação interventricular e troca valvar, 359 plastia ou trocas valvares múltiplas ou isoladas. Por outro lado, em 2020, foram realizados 966 procedimentos cirúrgicos, entre os quais, 414 coronarianos, 225 valvares, 241 congênitos, 75 correções de aneurisma ou dissecção de aorta e 11 transplantes cardíacos. Houve uma redução global de 30,1%, na análise exclusiva da cirurgia de revascularização miocárdica, a redução foi de aproximadamente 29,9%. CONCLUSÃO: Muitos questionamentos ainda permanecem no cenário pós-pandemia, a adaptação dos serviços cirúrgicos à abordagem destes pacientes assim como as complicações inerentes da infecção por COVID-19 em consonância àquelas da doença cardiovascular demandarão mais estudos a fim de esclarecer tantos pontos.