Complicações após cirurgia de revascularização miocárdica em pacientes idosos

Abstract

Due to the increasing longevity of the and high prevalence of coronary heart disease in the aged, coronary artery bypass graft surgery has become frequent in older patients. The purpose of this study is to describe operative features, length of stay, complications and short term outcomes after coronary artery bypass graft in such patients. Methods: From February 2005 to October 2007, 269 patients underwent coronary artery bypass graft. Demographic data, comorbidities, prognostic scores, coronary artery bypass graft elective versus urgent indication, intensive care unit length of stay, postoperative complications and intensive care unit mortality were recorded. Intra-operative characteristics, such as total surgery time, use of bypass device, on-pump time, urine output, fluid balance, use of blood products and number of grafts, were analyzed. Patients were divided in four age groups: group I (< 60 n = 68), II (60 to 69 n = 86), III (70 to 79 n = 93) IV and older than 80 years (n = 22). Results: Group IV patients were more frequently submitted to coronary artery bypass graft combined with valve replacement, emergency surgery, and had longer stay in the intensive care unit (p < 0.01). The incidence of at least one postoperative complication was also higher among patients older than 80 (p < 0.001). Multivariate analysis identified age and on-pump time as independent risk factors for development of complications. Mortality increased in patients older than 70 years (p = 0.03). Conclusions: Octogenarian patients undergoing coronary artery bypass graft have longer intensive care unit length of stay, incidence of complications and mortality. Age and onpump time were independent risk factors associated with the incidence of postoperative complications.

Características clínico-demográficas de pacientes submetidos a cirurgia de revascularização do miocárdio e sua relação com a mortalidade

“…Moreover, CPB of longer duration activates the immune system and clears inflammatory mediators, resulting in several organ dysfunctions. As a result, postoperative complication is more likely to increase along with the duration of CPB [12,25,26]. In this study, the association between a longer CPB duration and an increased mortality rate was observed, confirming the reports of other authors that the duration of CPB was significantly longer in the non-survivor group.…”

“…The mortality rate related to CABG and observed in studies restricted to the elderly population tends to be higher (9.3% to 16.3%) [8][9][10]. In studies of more heterogeneous populations, the mean age of the non-survivors is usually significantly higher [3,[11][12][13][14]. These data corroborate the results presented here, where an age over 70 years old is associated with a 2.7-fold increase in the risk of a hospital death after CABG.…”

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003

“…On the other hand, while almost 60% failure, critical preoperative status, prior revascularization, and lesion of the left main coronary artery or combined with other vessels. Prevalence of SABP was higher than that observed in similar studies 12,13 , whereas prevalences of dyslipidemia and diabetes are within those reported in literature 4,12,13 .…”

“…Therefore, the record of complications is also an indicator of prognosis. A high prevalence of at least one postoperative complication (41%) was reported in another study 4 .…”

Caracterização dos octogenários submetidos à cirurgia cardiovascular sob intervenção fisioterapêutica

“…As complicações pós-operatórias pulmonares estão associadas à esternotomia, presença de drenos pleurais, dor, que, por sua vez, propiciam a formação de atelectasias e alteram as trocas gasosas. A incidência em nossa amostra foi de 36%, semelhante a de outros estudos 12,13 . Independentemente da idade, o uso da artéria torácica interna, a cirurgia valvar e o tempo de CEC são considerados fatores de risco para o desenvolvimento de complicações pulmonares pós-operatórias 14 .…”