IntroductionFluid overload is a clinical problem frequently related to cardiac and renal dysfunction. The aim of this study was to evaluate fluid overload and changes in serum creatinine as predictors of cardiovascular mortality and morbidity after cardiac surgery.MethodsPatients submitted to heart surgery were prospectively enrolled in this study from September 2010 through August 2011. Clinical and laboratory data were collected from each patient at preoperative and trans-operative moments and fluid overload and creatinine levels were recorded daily after cardiac surgery during their ICU stay. Fluid overload was calculated according to the following formula: (Sum of daily fluid received (L) - total amount of fluid eliminated (L)/preoperative weight (kg) × 100). Preoperative demographic and risk indicators, intra-operative parameters and postoperative information were obtained from medical records. Patients were monitored from surgery until death or discharge from the ICU. We also evaluated the survival status at discharge from the ICU and the length of ICU stay (days) of each patient.ResultsA total of 502 patients were enrolled in this study. Both fluid overload and changes in serum creatinine correlated with mortality (odds ratio (OR) 1.59; confidence interval (CI): 95% 1.18 to 2.14, P = 0.002 and OR 2.91; CI: 95% 1.92 to 4.40, P <0.001, respectively). Fluid overload played a more important role in the length of intensive care stay than changes in serum creatinine. Fluid overload (%): b coefficient = 0.17; beta coefficient = 0.55, P <0.001); change in creatinine (mg/dL): b coefficient = 0.01; beta coefficient = 0.11, P = 0.003).ConclusionsAlthough both fluid overload and changes in serum creatinine are prognostic markers after cardiac surgery, it seems that progressive fluid overload may be an earlier and more sensitive marker of renal dysfunction affecting heart function and, as such, it would allow earlier intervention and more effective control in post cardiac surgery patients.

objective: To compare the clinical and surgical profile between two groups of patients submitted to Myocardial Revascularization (MCR) surgery at the Instituto de Cardiologia of Rio Grande do Sul with a ten year interval, to observe its influence upon MCR hospital mortality and to verify the predictability of this result using the risk score. Methods:A retrospective cohort study involving 307 patients who underwent MCR surgery within a six month period during 1991/92 (INITIAL group, n=153) or 2001/02 (CURRENT group, n=154). Demographic characteristics, heart disease, comorbidities and surgical events were analyzed to compare the groups and to define the hospital mortality risk score (based on the Cleveland Clinic method). results:The CURRENT group was older, had more severe heart condition (functional class, incidence of heart failure and number of vessels with severe lesions) and a greater prevalence of comorbidities. The INITIAL group had a higher prevalence of nonelective surgery. Both groups had similar mean risk scores (2.8 + 3.1 for INITIAL and 2.2 + 2.5 for CURRENT) and hospital mortality rates (3.3% and 1.9% respectively). These figures are comparable to those for reported by Cleveland Clinic (for a risk score of 3 the predicted mortality range between 2.0 %; using a confidence level of 95% the predicted mortality is between 0 and 4.3%; and actual mortality confirmed by the study was 3.4%). conclusion:Patients currently submitted to MCR are older and in worse clinical condition (heart and systemic) than those operated on ten years ago; however, the risk scores and hospital mortality rates were slightly higher in the INITIAL group. The higher number of nonelective surgical interventions could have contributed to this. A risk score can be used to identify patients that require a higher level of care and to predict surgical outcomes.

RBCCV Modificações no perfil do paciente submetido à operação de revascularização do miocárdio Changes in profile of patients submitted to coronary bypass graft surgery

Background: The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group.

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