RESUMO
OBJECTIVE: To determine whether preoperative aspirin-acetylsalicylic acid (ASA)-timing or dose independently affects 30-day all-cause mortality. BACKGROUND: Preoperative ASA administration is associated with reduced morbidity and mortality after coronary artery bypass graft (CABG). However, data are lacking regarding optimal timing and dosing of ASA. METHODS: We retrospectively reviewed data from 3018 consecutive patients who underwent CABG surgery between July 2005 and May 2011. Patients were assigned to 3 groups according to the time of the last preoperative ASA dose: (1) 24âhours or less preoperatively (nâ=â1173), (2) between 24 and 72âhours (nâ=â876), and (3) more than 72âhours or none (nâ=â969). In a separate analysis, patients were grouped according to ASA dose: 81âmg (nâ=â1285), 325âmg (nâ=â1004), and none (nâ=â543). The primary outcome was 30-day all-cause mortality. RESULTS: The 30-day mortality rate was significantly lower in patients who took ASA 24âhours or less preoperatively (1.5%) than in those who took it between 24 and 72âhours (3.2%) or more than 72âhours or none (2.9%). Multivariate analysis showed that ASA within 24âhours preoperatively was associated with reduced mortality (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.20-0.82; Pâ=â0.01). Moreover, mortality was significantly reduced for patients taking 81âmg of ASA (1.4%) compared with 325âmg (2.9%) or none (3.9%). Multivariate analysis demonstrated that 81âmg of ASA decreased mortality risk by 66% (OR, 0.34; 95% CI, 0.18-0.66; Pâ<â0.01), whereas 325âmg of ASA had no mortality benefit (OR, 0.74; 95% CI, 0.41-1.35; Pâ=â0.33) compared with no ASA. CONCLUSIONS: Low-dose ASA use within 24âhours of CABG is independently associated with decreased early postoperative mortality.
Assuntos
Aspirina/administração & dosagem , Ponte de Artéria Coronária/mortalidade , Inibidores da Agregação Plaquetária/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspirina/uso terapêutico , Esquema de Medicação , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Selective antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) provides cerebral protection during aortic arch surgery. However, the ideal temperature for HCA during ACP remains unknown. Clinical outcomes were compared in patients who underwent moderate (nasopharyngeal temperature, ≥ 20 °C) versus deep (nasopharyngeal temperature, <20 °C) HCA with ACP during aortic arch repair. METHODS: By using a prospectively maintained clinical database, we analyzed data from 221 consecutive patients who underwent aortic arch replacement with HCA and ACP between December 2006 and May 2009. Seventy-eight patients underwent deep hypothermia (mean lowest temperature, 16.8 °C ± 1.7 °C) and 143 patients underwent moderate hypothermia (mean, 22.9 °C ± 1.4 °C) before systemic circulatory arrest was initiated. Multivariate stepwise logistic and linear regressions were performed to determine whether depth of hypothermia independently predicted postoperative outcomes and blood-product use. RESULTS: Compared with moderate hypothermia, deep hypothermia was associated independently with a greater risk of in-hospital death (7.7% vs 0.7%; odds ratio [OR], 9.3; 95% confidence interval [CI], 1.1-81.6; P = .005) and 30-day all-cause mortality (9.0% vs 2.1%; OR, 4.7; 95% CI, 1.2-18.6; P = .02), and with longer cardiopulmonary bypass time (154 ± 62 vs 140 ± 46 min; P = .008). Deep hypothermia also was associated with a higher incidence of stroke, although this association was not statistically significant (7.6% vs 2.8%; P = .073; OR, 4.3; 95% CI, 0.9-12.5). No difference was seen in acute kidney injury, blood product transfusion, or need for surgical re-exploration. CONCLUSIONS: Moderate hypothermia with ACP is associated with lower in-hospital and 30-day mortality, shorter cardiopulmonary bypass time, and fewer neurologic sequelae than deep hypothermia in patients who undergo aortic arch surgery with ACP.
Assuntos
Aorta Torácica/cirurgia , Transtornos Cerebrovasculares/prevenção & controle , Parada Circulatória Induzida por Hipotermia Profunda , Hipotermia Induzida , Perfusão , Procedimentos Cirúrgicos Vasculares , Idoso , Transfusão de Sangue , Ponte Cardiopulmonar , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/fisiopatologia , Distribuição de Qui-Quadrado , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/mortalidade , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Perfusão/efeitos adversos , Perfusão/mortalidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidadeRESUMO
Left atrial (LA) dissection is an uncommon entity that occurs most often after mitral valve surgery. We present a case of a 52-year-old man who developed an LA dissection after repair of a postinfarction left ventricular (LV) aneurysm. Transesophageal echocardiography was used to establish the diagnosis of an LA dissection that almost completely occluded the LA, limiting LV filling and causing hemodynamic instability.