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.

Thinking Outside the Box: The Interventional Surgeon.

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Thinking outside the box: the interventional surgeon

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Fibrilação atrial após cirurgia de revascularização miocárdica e sua relação com complicações hospitalares: análise do registro paulista de cirurgia cardiovascular (REPLICCAR II) / Atrial fibrillation after coronary artery bypass grafting and its relationship with hospital complications: analysis of the cardiovascular surgery registry in São Paulo (REPLICCAR II)

INTRODUÇÃO: A fibrilação atrial constitui a principal complicação no pós-operatório de cirurgia cardiovascular. Sua gênese é multifatorial, portanto, sua rápida identifi cação é fundamental para mitigar os riscos associados. OBJETIVO: Avaliar a incidência de fi brilação atrial em pacientes submetidos à cirurgia de revascularização miocárdica (CRM) e sua relação com outras complicações no nosso cenário. MÉTODOS: Análise retrospectiva de pacientes submetidos à CRM isolada entre 2017 e 2019, pertencentes ao Registro Paulista de Cirurgia Cardiovascular (REPLICCAR II). As variáveis foram coletadas prospectivamente no REDCap seguindo as defi nições dadas pela versão 2.73 do STS Adult Cardiac Surgery Database. Os dados foram coletados com autorização prévia do Comitê de Ética local e as análises, realizadas no software R. RESULTADOS: Foram incluídos 3.803 pacientes, dos quais 605 apresentaram fi brilação atrial no pós-operatório (FAPO). De forma a ajustar os grupos, foi utilizado propensity score matching entre as seguintes variáveis (insufi ciência renal crônica/ aguda; classifi cação NYHA; diabetes mellitus; doença arterial periférica; ex-tabagista/tabagista; gênero; infarto agudo do miocárdio; necessidade de balão intra-aórtico; status cirúrgico; transfusão de hemoderivados no intraoperatório). Tais análises resultaram em 605 pacientes em cada grupo (sem FAPO vs. com FAPO). Entre os pacientes com FAPO, a média de idade foi de 67,56 anos, com prevalência do sexo masculino (445 pacientes, 73,6%). Não houve diferença estatística entre comorbidades (hipertensão arterial sistêmica, diabetes mellitus e dislipidemia), fração de ejeção, classe funcional ou risco cirúrgico (EuroSCORE). Pacientes pertencentes ao grupo com FAPO apresentaram mortalidade de 9,26% (P = 0,007), maior tempo de ventilação prolongada (P < 0,001), readmissão na unidade de terapia intensiva (P < 0,001), pneumonia (P < 0,001) e sepse (P < 0,001). Na análise múltipla, os tempos de ventilação mecânica (P = 0,044) e permanência na UTI (P < 0,001), bem como disfunção renal aguda (P = 0,032), estiveram associados à presença de FAPO. CONCLUSÃO: A fi brilação atrial no pós-operatório de CRM está associada com maior tempo de UTI e de internação, assim como com disfunção renal, pneumonia e mortalidade hospitalar.