Desfechos clínicos pós-revascularização do miocárdio no paciente idoso

Abstract

Desfechos clínicos pós-revascularização do miocárdio no paciente idoso Outcomes after coronary artery bypass in aged patientsWork performed at the Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. Results: We analyzed 290 patients that possessed appropriate information. The first group G1, of the patients operated without CPB consisted of 111 patients and the second group G2, of the operated ones with CPB consisted of 179 patients. The univariated analysis presented statistics significance for the variables: cardiac insufficiency functional class preoperative (P=0.000), tobacco smoking (P=0.050), number of performed grafts (P=0.050), graft type (P=0.000), associated procedures (P=0.000), preoperative use of intra-aortic balloon (P=0.000), hospital mortality (P=0.000) and type of death (P=0.020). In the postoperative outcomes it was significant only the incidence of brain stroke (CVA) in G2 (P=0.036). In the long term there was higher incidence of reinternment for angina (P=0,038). The analysis of the survival curves presented statistic difference (P=0.009; LogRank Test).Conclusions: CABG without CPB, in this series, proved to be beneficial for the octogenarian patients in the short term, due to the patients having presented lower incidence of brain stroke in the immediate postoperative, whereas in the long term there was higher incidence of re-internments for angina in G1 and higher prevalence of cardiac deaths in G2. Resultados: Na análise univariada apresentaram significância: insuficiência cardíaca congestiva pré-operatória (P=0,000), tabagismo (P=0,050), número de enxertos realizados (P=0,050), tipo de enxerto (P=0,000), procedimentos associados (P=0,000), uso de balão intraaórtico no pós-operatório (P=0,000), óbito hospitalar (P=0,000) e tipo de morte (P=0,020). No pós-operatório imediato, foi significativa apenas a incidência de acidente Descriptors 230 IGLÉZIAS, JCR ET AL -Outcomes after coronary artery bypass in aged patientsRev Bras Cir Cardiovasc 2010; 25(2): 229-233

A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada

“…They found that on-pump CABG had a higher mortality rate compared to off-pump CABG (11.5% vs. 2.1%, respectively). However, unlike Iglézias et al [18], they observed a higher incidence of other postoperative complications: stroke (CVA) (11.5% vs. 0%); AF (30.8% vs. 12.8%), AKI (19.2% vs. 0%), respiratory failure (16% vs. 2.1%), dialysis (20% vs. 0%), mechanical ventilation > 24 h (24% vs. 4.3%) and AMI (8% vs. 4.3%) respectively in on-pump vs. off-pump CABG.…”

“…Iglézias et al [18] compared the clinical outcomes in patients aged ≥ 80 years undergoing on-pump versus off-pump CABG. They reported an operative hospital mortality rate much higher in on-pump CABG (38%) than in off-pump CABG (11.7%) [18]. However, other postoperative complications were similar.…”

“…However, other postoperative complications were similar. Thus, the incidence of myocardial infarction was 3.4% vs 2.8%; stroke (CVA) was 0% vs. 4%; assisted ventilation > 24 hours 27.4% vs 21.1% and reoperation 2.9% vs. 1.9%, respectively for on-pump vs. of-pump CABG [18]. In a similar analysis, Lee et al [19] retrospectively compared the results of on-pump vs. off-pump CABG.…”

Six-minute walk test as a tool for assessing the quality of life in patients undergoing coronary artery bypass grafting surgery

“…The coronary artery bypass grafting (CABG) aims to increase survival, to relieve symptoms of myocardial ischemia, to improve ventricular function, to prevent myocardial infarction, to recover the patient physically, psychologically, and socially, as well as to prolong patient's life and QOL [1][2][3][4][5][6].…”