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

RBCCV Modificações no perfil do paciente submetido à operação de revascularização do miocárdio Changes in profile of patients submitted to coronary bypass graft surgery Abstract Introduction: The improvement in care and management of ischemic heart disease and the dissemination of percutaneous coronary intervention (PCI) changed the indications for coronary artery bypass grafting (CABG), regarding the procedure for multiarterial diseased patients with worse clinical conditions. Objective: To compare CABG patients surgical and clinical profiles between two groups with a 10 year interval. Evaluate post-operative mortality and severity risk scores.Method: Retrospective Cohort study, including 307 CABG patients operated in 1991/92 (n=153) and 2001/02 (n=154). Demographic characteristics, heart disease severity, comorbidities and pre-operative events were evaluated and compared between groups.Results: Patients operated in 2001/02 were older, more severe (worse NYHA class, prevalence of heart failure, and multiarterial diseased) and with more comorbidities. Patients operated in 1991/92 had more urgent procedures. The observed surgical mortality rates were similar (3,3% and 1,9%, respectively). Conclusion: Patients submitted to CABG currently are older and in worse clinical conditions than those operated 10 years ago, but hospital mortality wasn't altered significantly. Descriptors: Myocardial revascularization. Risk assessment. Heart diseases, surgery. Resumo Introdução: Indicações da operação de revascularização miocárdica (RM) foram modificadas pela introdução de novas FEIER, FH ET AL -Changes in profile of patients submitted to coronary bypass graft surgery Braz J Cardiovasc Surg 2005; 20(3): 317-322 drogas e da angioplastia coronária transluminal percutânea (ACTP), sendo o procedimento cada vez considerado em pacientes com doença multiarterial coronária e de condição clínica mais grave.Objetivo: Comparar perfil clínico e cirúrgico entre dois grupos de pacientes submetidos a RM com intervalo de 10 anos, bem como observar sua influência na mortalidade hospitalar.Método : Estudo de coorte retrospectivo, envolvendo 307 pacientes submetidos a RM em 1991/92 (grupo INICIAL, n=153) ou 2001/02 (grupo ATUAL, n=154). Para cada grupo foram identificadas características demográficas, doenças cardíacas, co-morbidades e eventos operatórios, visando comparação e determinação dos fatores relacionados à mortalidade hospitalar aumentada.Resultados: Grupo recente tinha idade mais avançada, condição cardíaca mais grave(classe funcional, prevalência de insuficiência cardíaca e número de vasos com lesão grave) e maior prevalência de co-morbidades. Pacientes iniciais mostraram maior prevalência na indicação cirúrgica de urgência. Não ocorreu diferença na mortalidade hospitalar (respectivamente 3,3% e 1,9% para grupos INICIAL e ATUAL).Conclusões: Pacientes atualmente submetidos a RM são mais idosos e de condição clínica mais grave (cardíaca e sistêmica) que os operados há 10 anos, embora isto não tenha influenciado de modo significativo...

Methods: From 1992 to 2000, 304 patients were discharged from hospital after bioprosthesis implantation. Ages ranged from 15 to 83 years (mean: 60.6 ± ± ± ± ± 14.3 years) and 50.3% were male. Patient deaths and events related to bioprosthesis (infection, thromboembolism and structural failure) were considered for estimation of cumulative probability of survival and event-free survival.Results: Total follow-up was 931.0 patients-year. During follow-up there were 28 (9.2%) deaths. Causes were bioprosthesis failure in five (1.6%), cardiac in seven (2.3%), non-cardiac in four (1.3%), and unknown in 12 (3.9%) patients. Events related to bioprosthesis were: endocarditis: 18 (5.9%), fibrocalcific degeneration: 15 (4.9%), thromboembolism: three (1.0%), hemolysis: one (0.3%). Bioprosthesis dysfunctions resulted in 16 (5.2%) reoperations due to fibrocalcific degeneration (nine), endocarditis (six) and thromboembolism (one). Probability of survival was higher in the young population (< 40 years, n=35) when compared to the older group (> 60 year, n=187): 82.0 ± ± ± ± ± 13.3% vs. 58.8 ± ± ± ± ± 13.6% in the 9 th year. Event-free survival was 77.5 ± ± ± ± ± 3.7% for 5 th year and 40.2 ± ± ± ± ± 9.0% for 10 th year. 424BACCO, FW ET AL -St Jude Medical-Biocor bovine pericardial bioprosthesis: long-term survival Braz J Cardiovasc Surg 2005; 20(4): 423-431 Resultados: Em um seguimento total de 931,0 pacientesano, ocorreram 28 (9,2%) óbitos tardios, sendo cinco (1,6%) relacionados à bioprótese, sete (2,3%) cardíacos, quatro (1,3%) não-cardíacos e 12 (3,9%)

Objective: To compare results of aortic valve replacement in patients with normal valve annulus and in those requiring annular enlargement. Method: Study includes 22 patients submitted to anterior and posterior annulus enlargement and 23 patients with a normal aortic annulus. Both groups were matched in gender, age, valvar lesion, etiology of cardiac disease and associated lesions. Patients with normal annuli had usual valve replacement. For those who required annular enlargement, posterior enlargement was performed by incision in the mid portion of the non-coronary sinus up to the anterior mitral leaflet. Anterior enlargement resulted from an incision between left and right coronary ostia extended to the ventricular septum for 2 cm. The aorta was reconstructed using bovine pericardium patches. The diameter of aortic annulus at surgery, clinical evolution (2 to 11 years followup) and left outflow tract obstruction (Doppler echocardiography) were considered. Results: Enlargement increased aortic annulus from 18.3 ± 2.2 mm to 24.8 ± 2.0 mm (p<0.001), a value similar to those with normal aortic annulus: 24.9 ± 1.5 mm (NS). Cardiopulmonary bypass time was longer in patients with enlargement (122.1 ± 38.9 min vs. 91.0 ± 30.7 min; p<0.005), as was aortic cross-clamp time (91.6 ± 20.7 min vs. 68.0 ± 23.5 min; p<0.001). For annular enlargement, peak systolic gradient at the prosthesis decreased from 83.6 ± 22.3 mmHg (pre-operative) to 26.7 ± 11.4 mmHg (p<0.01) in the last evaluation. For normal annulus, reduction from 68.2 ± 28.7 mmHg to 32.8 ± 16.2 mmHg occurred (p<0.001) (final values comparable between groups; NS). Conclusion: The anterior and posterior aortic annulus enlargement technique allowed an increase in the annular diameter and valvar prosthesis, providing up to 11 years followup, a clinical and echocardiographic result similar to those observed in patients with valve replacement with a normal annulus.

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