Influências temporais nas características e fatores de risco de pacientes submetidos a revascularização miocárdica

Abstract

objective: To compare the clinical and surgical profile between two groups of patients submitted to Myocardial Revascularization (MCR) surgery at the Instituto de Cardiologia of Rio Grande do Sul with a ten year interval, to observe its influence upon MCR hospital mortality and to verify the predictability of this result using the risk score. Methods:A retrospective cohort study involving 307 patients who underwent MCR surgery within a six month period during 1991/92 (INITIAL group, n=153) or 2001/02 (CURRENT group, n=154). Demographic characteristics, heart disease, comorbidities and surgical events were analyzed to compare the groups and to define the hospital mortality risk score (based on the Cleveland Clinic method). results:The CURRENT group was older, had more severe heart condition (functional class, incidence of heart failure and number of vessels with severe lesions) and a greater prevalence of comorbidities. The INITIAL group had a higher prevalence of nonelective surgery. Both groups had similar mean risk scores (2.8 + 3.1 for INITIAL and 2.2 + 2.5 for CURRENT) and hospital mortality rates (3.3% and 1.9% respectively). These figures are comparable to those for reported by Cleveland Clinic (for a risk score of 3 the predicted mortality range between 2.0 %; using a confidence level of 95% the predicted mortality is between 0 and 4.3%; and actual mortality confirmed by the study was 3.4%). conclusion:Patients currently submitted to MCR are older and in worse clinical condition (heart and systemic) than those operated on ten years ago; however, the risk scores and hospital mortality rates were slightly higher in the INITIAL group. The higher number of nonelective surgical interventions could have contributed to this. A risk score can be used to identify patients that require a higher level of care and to predict surgical outcomes.

Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca

“…Cardiac surgery in the elderly is associated with high morbidity and mortality due to the high prevalence of comorbidities and lower functional reserve of these patients [4,30,37]. Low body mass index (BMI) may increase the frequency of postoperative complications in the elderly undergoing coronary artery bypass grafting [2,30,38,42].…”

“…Cardiac surgeries are major surgeries broadcasted worldwide, among them stands out mostly coronary artery bypass (CABG) and valve replacement [1][2][3][4].…”

“…The morbidity and mortality in the postoperative of cardiac surgeries is of great interest, prompting several protocols for postoperative management [1][2][3][4]. The ischemic asymptomatic episodes are very frequent and seem to imply a worse prognosis [11,12].…”

“…Because of hemodynamic instability that can happen in the immediate postoperative period, the patient may need inotropic support (VAD) and must remain in the Intensive Care Unit (ICU) while there is need [15][16][17]. The controls of vital data, such as capillary blood glycemia and monitoring are performed on an hourly basis, which can also bring discomfort to the patient [2,[18][19][20][21].…”

Avaliação de saúde e da dor no pós-operatório de idosos submetidos à cirurgia cardíaca

“…A cirurgia cardíaca é realizada quando a probabilidade de uma vida útil é maior com o tratamento cirúrgico do que com o tratamento clínico. 5 Trata-se de um procedimento complexo, que implica em alterações fisiológicas, e impõe um grande estresse orgânico.…”