The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

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Introduction Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry

Paez¹,

Hossne²,

Santo³

et al. 2019

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“…An important headway was provided with the inception of the first Brazilian national database of cardiovascular surgery in adults, the BYPASS Registry [3,4] . The BYPASS Registry is an ongoing database currently collecting information from 17 participating centers across the country, and steadily expanding the pool of contributing units.…”

Section: Introductionmentioning

confidence: 99%

Valve Heart Surgery in Brazil – The BYPASS Registry Analysis

Zilli¹,

Guizilini²,

Rocco³

et al. 2020

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Objective: To analyze the profile and outcomes of patients who underwent valve heart surgery in Brazil, using information retrieved from the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS Registry) database.Methods: This is a multicenter cohort study, evaluating 920 patients submitted to heart valve surgery. Demographics and postoperative clinical outcomes were assessed and compared to estimate mortality risk using the European System for Cardiac Operative Risk Evaluation (EuroSCORE).Results: Isolated aortic valve replacement was the most frequently performed surgery (34%), followed by isolated mitral valve replacement (24.9%). Valve repair was performed in 21% of mitral procedures. Minimally invasive access was performed in 1.6% and the most frequent postoperative complications were arrhythmias (22.6%), infections (5.7%), and low-output syndrome (5.1%). Operations covered by the public health system accounted for 80.8% and the hospital mortality rate was 7.3%.Conclusion: The most frequent isolated valve surgery in Brazil is the aortic valve replacement by conventional open access and the rheumatic disease is still the main etiology for valve surgery. The BYPASS Registry has a fundamental role to provide information on the profile of patients with valve heart disease in our country in order to delineate adequate strategies for health promotion and resource allocation for cardiac surgery.

“…In the United States of America (USA), 160,160 CABG were performed in 2017 [ 1 ] . From August 2014 to December 2016, 54.1% of cardiac surgeries performed in Brazil were CABG [ 2 ] . In 2013, the mean rate of CABG in the countries of the Organization for Economic Co-operation and Development was 44 per 100,000 inhabitants [ 3 ] , whereas in Brazil, between 2000 and 2017, the gross rate of CABG financed by the Brazilian Unified Health System ranged between 15.1 and 18.3 per 100,000 inhabitants aged 20 years or more [ 4 ] .…”

Section: Introductionmentioning

confidence: 99%

Predictors of Hospital Readmission within 30 Days after Coronary Artery Bypass Grafting: Data Analysis of 2,272 Brazilian Patients

Chiorino¹,

Santos²,

Lopes³

et al. 2020

Introduction In order to reduce readmission rates after coronary artery bypass grafting (CABG), its predictors should be known in different contexts. The objective of this study was to identify predictive factors of hospital readmission within 30 days after CABG in a Brazilian center. Methods A secondary analysis of an electronic database of patients submitted to isolated CABG was performed. The relationship between readmission within 30 days and demographic, anthropometric, clinical, and surgery-related characteristics was investigated by univariate analyses. Predictors were identified by multiple logistic regression. Results Data from 2,272 patients were included, with an incidence of readmission of 8.6%. The predictors of readmission were brown skin color (Beta=1.613; 95% confidence interval [CI] 1.047-2.458; P =0.030), African-American ethnicity (Beta=0.136; 95% CI 0.019-0.988; P =0.049), chronic kidney disease (Beta=2.214; 95% CI 1.269-3.865; P =0.005), postoperative use of blood products (Beta=1.515; 95% CI 1.101-2.086; P =0.011), chronic obstructive pulmonary disease (Beta=2.095; 95% CI 1.284-3.419; P =0.003), and use of acetylsalicylic acid (Beta=1.418; 95% CI 1.000-2.011; P =0.05). Preoperative antibiotic prophylaxis (Beta=0.742; 95% CI 0.5471.007; P =0.055) was marginally significant. Conclusion The predictors identified may support a closer postoperative follow-up and individualized planning for a safe discharge.