Impacto da disfunção renal na evolução intra-hospitalar após cirurgia de revascularização miocárdica

Barbosa, Roberto Ramos; Cestari, Priscila Feitoza; Capeletti, Julhano Tiago; Peres, G; Ibañez, Tânia L. P; Silva, Patrícia Viana da; Farran, Jorge; Amato, Vivian Lerner; Farsky, Pedro Sílvio

doi:10.1590/s0066-782x2011005000075

Cited by 16 publications

(7 citation statements)

References 26 publications

(26 reference statements)

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“…A similar condition is observed in other studies with dialytic patients 14-16 , and maybe these complications are related to the metabolic particularities of these patients, such as electrolytic unbalance, atherosclerotic process, and exacerbated inflammation 21 . Seven patients (14%) died during the in-hospital period, less than in some reference centers in the country 14 , and similar to the percentage found in the Society of Thoracic Surgeon 16 database.…”

Section: Discussionsupporting

confidence: 84%

“…The percentages of these risk factors and history of cardiovascular disease (stroke, peripheral arterial disease, events or previous coronary interventions) are similar to those published by Longnecker et al through CHOICE (Choices for Healthy Outcomes in Caring for End-Stage Renal Disease) 3 study. Other studies 14-18 have also shown high prevalence of risk factors and previous cardiovascular diseases. In our study, 92% of patients had preserved left ventricular function, and 52% did not have symptoms like angina or dyspnea.…”

Section: Discussionmentioning

confidence: 88%

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Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

Miranda¹,

Hossne²,

Branco³

et al. 2013

Arquivos Brasileiros De Cardiologia

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Background Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. ObjectiveEvaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Methods Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. Results High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. ConclusionCoronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 88%

Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

Miranda¹,

Hossne²,

Branco³

et al. 2013

Arquivos Brasileiros De Cardiologia

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“…Além disso, a baixa perfusão renal, a hipotensão arterial e a queda do débito cardíaco são fatores que aceleram a disfunção renal. Apesar de todo o aperfeiço-amento técnico, processos infecciosos têm alta incidência, sendo uma das maiores causas de morbidade e mortalidade em pacientes cirúrgicos (3,(15)(16)(17)(18) . …”

Section: Methodsunclassified

Complicações Pós-Operatórias Em Pacientes Submetidos À Cirurgia Cardíaca Em Hospital De Ensino

Beccária¹,

Cesarino²,

Werneck³

et al. 2015

ACS

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ResumoIntrodução: A taxa de mortalidade hospitalar é indicador de resultados para avaliação da qualidade da assistência em unidade coronária. Objetivos: Caracterizar os pacientes submetidos à cirurgia cardíaca, identificar os tipos de cirurgia e as principais complicações nos primeiros 30 dias pós-cirurgia. Material e Métodos: Estudo retrospectivo, longitudinal, quantitativo envolvendo pacientes submetidos a cirurgia cardíaca em um hospital de ensino, de janeiro de 2003 a abril de 2012. Resultados: Foram avaliados 2.648 pacientes, 61% do sexo masculino e 39% do feminino, com idade entre 49 a 66 anos, com média de Índice de Massa Corpórea de 26. As doenças de base mais comuns foram Diabetes Mellitus e Doença Renal Crônica. Realizaram revascularização do miocárdio 1.641 pacientes (62%) e cirurgia valvar 1.007 (38%). As principais complicações pós-operatórias foram lesão renal aguda até 7º dia pós-operatório (32%), disfunção de ventrículo esquerdo moderada/grave (20%), reintubação por complicações pulmonares (11%), fibrilação atrial (8,6%) e lesão neurológica (4,3%). O tempo médio de permanência na Unidade Coronária foi de 6,8 dias e a maioria necessitou de circulação extracorpórea. Dos 22% de pacientes com história pregressa de diabetes, 25% morreram. Conclusões: A maioria submeteu-se à revascularização do miocárdio; 65% desenvolveram lesão renal aguda e 44% foram reintubados por complicações pulmonares e associação significativa com óbito. Dos 190 pacientes que morreram nos primeiros 30 dias, as complicações de maior prevalência foram afecções cardíacas, infecção hospitalar, distúrbio de coagulação, complicações neurológicas e pulmonares. Descritores:Complicações; Óbito; Pós-operatório; Cirurgia Cardíaca. Abstract Introduction: Hospital mortality rate is an indicator of outcomes to evaluate the quality of health care in a coronary care unit. Objectives: The aims of the present study are to characterize patients undergoing cardiac surgery, as well as to identify the types of surgery and its main complications in the first 30 postoperative days. Material and Methods: We carried out a retrospective longitudinal study using a quantitative approach involving patients who underwent cardiac surgery at a teaching hospital from January 2003 to April 2012. Results: We evaluated 2,648 patients, 61% males, and 39% females, with a mean age ranging from 49 to 66 years. Patients mean Body Mean Index was 26. The most common underlying diseases were diabetes mellitus and chronic renal insufficiency. We performed Coronary Artery Bypass Grafting in 1,641 patients (62%) and heart valve surgery in 1,007 (38%). The main postoperative complications were acute kidney injury on the 7 th postoperative day 7 (32%), moderate to severe left ventricular dysfunction (20%), reintubation due to pulmonary complications (11%), atrial fibrillation (8.6%), and neurological lesions (4.3%). The mean length of stay in Coronary Care Unit was 6.8 days. The majority of the patients required cardiopulmonary bypass. Of the 22% of patients with a prior histo...

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“… 1 High rates of complications and hospital mortality have been reported in patients with renal dysfunction who undergo myocardial revascularization surgery. 2 Therefore, a more reliable, individualized assessment of renal function may lead to better optimization and allocation of resources that may help physicians and patients choose the best time and type of treatment.…”

Section: Introductionmentioning

confidence: 99%

Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery?

Arthur

Mejía

Osternack

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundRenal dysfunction is an independent predictor of morbidity and mortality in cardiac surgery. For a better assessment of renal function, calculation of creatinine clearance (CC) may be necessary.ObjectiveTo objectively evaluate whether CC is a better risk predictor than serum creatinine (SC) in patients undergoing cardiac surgery.MethodsAnalysis of 3,285 patients registered in a prospective, consecutive and mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery (REPLICCAR) between November 2013 and January 2015. Values of SC, CC (Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC and CC with morbidity and mortality was performed by calibration and discrimination tests. Independent multivariate models with SC and CC were generated by multiple logistic regression to predict morbidity and mortality following cardiac surgery.ResultsDespite the association between SC and mortality, it did not calibrate properly the risk groups. There was an association between CC and mortality with good calibration of risk groups. In mortality risk prediction, SC was uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve showed that CC is better than SC in predicting both morbidity and mortality risk. In the multivariate model without CC, SC was the only predictor of morbidity, whereas in the model without SC, CC was not only a mortality predictor, but also the only morbidity predictor.ConclusionCompared with SC, CC is a better parameter of renal function in risk stratification of patients undergoing cardiac surgery.

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Impacto da disfunção renal na evolução intra-hospitalar após cirurgia de revascularização miocárdica

Abstract: Background: Chronic kidney disease (CKD) is a predictor of increased mortality in patients undergoing coronary artery bypass surgery (CABG).

Cited by 16 publications

References 26 publications

Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

Complicações Pós-Operatórias Em Pacientes Submetidos À Cirurgia Cardíaca Em Hospital De Ensino

Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery?

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