Perfil das Cirurgias Cardíacas Valvares no Brasil Análise do Registro Bypass

BACKGROUND: Valvular heart diseases are the second cause of cardiac surgeries in the world. However, the patients’ profile, etiology of valve diseases and surgical results differ according to the population and country studied. In Brazil, the BYPASS (Brazilian Registry of Cardiovascular Surgeries in Adults) project aims to map the epidemiological aspects and results of surgical treatment of patients with heart disease. OBJECTIVE: To analyze the profile of valvular heart surgery performed in Brazil, using the BYPASS Registry database. METHOD: A multicenter observational / prospective cohort study with 17 participating centers in Brazil. We evaluated 920 patients submitted to cardiac valve surgeries isolated and / or associated from August 2014 to April 2018. Postoperative clinical outcomes: cardiopulmonary and infectious complications, length of stay in the Intensive Care Unit and hospital in the post-operatory and mortality, compared to estimated calculated mortality risk by EuroSCORE (European System for Cardiac Operative Risk Evaluation). RESULTS: The mean age of the patients was 56.7 years and women represented 47%. Isolated aortic valve replacement was the most frequently performed surgery (34%), followed by isolated mitral valve replacement (24.9%) and double-mitro-aortic valve replacement (13.3%). Valve repair was performed in 21% of mitral procedures. Minimally invasive access was performed at 1.6%. Invasive mechanical ventilation post-op >24hours occurred in 8.2%. The most frequent postoperative complications were arrhythmias (22,6%), infections (5.7%- 27% in surgical focus) and low-output syndrome (5.1%). Surgeries by the public system (Unique Health System) accounted for 80.8%. The hospital mortality rate was 7.3%, while mean logistic EuroSCORE was 7.9%. The rheumatic etiopathogenesis occurred in 38.3% of the operated patients. CONCLUSION: The most frequent isolated valve surgery in Brazil is the aortic valve replacement by conventional open access, followed by mitral valve replacement surgery and double valve replacement. Rheumatic disease was the main ethiopathogenic cause of valve surgeries in Brazil. Hospital mortality of valvular cardiac surgeries match corresponding logistic risk stratification by EuroScore, showing a medium to high risk population operated. The BYPASS registry became a fundamental tool to know 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.FUNDAMENTO: As doenças valvares constituem a segunda causa de cirurgias cardíacas no mundo. No entanto, o perfil dos pacientes e resultados diferem de acordo com a população e país estudado. No Brasil, o projeto BYPASS (Registro Brasileiro de Cirurgias Cardiovasculares em Adultos) visa mapear os aspectos epidemiológicos e resultados do tratamento cirúrgico dos pacientes com doenças cardíacas. OBJETIVO: Analisar o perfil das cirurgias cardíacas valvares realizadas no Brasil utilizando o banco de dados do registro BYPASS. MÉTODO: Estudo multicêntrico observacional/coorte prospectivo com 17 centros participantes no Brasil. Foram avaliados 920 pacientes submetidos a cirurgias valvares, isoladas e/ou associadas, de agosto de 2014 a abril de 2018. Os desfechos clínicos pós-operatórios avaliados foram: complicações cardiopulmonares e infecciosas; tempos de internação em Unidade de Terapia Intensiva e hospitalar no PO e mortalidade, comparada a mortalidade prevista calculada pelo EuroSCORE (Sistema Europeu de Avaliação do Risco Cirúrgico em Cirurgia Cardíaca). RESULTADOS: A idade média dos pacientes foi de 56,7 anos e mulheres representaram 47%. A troca valvar aórtica isolada foi a cirurgia mais frequentemente realizada (34%), seguida da troca valvar mitral isolada (24,9%) e posteriormente da dupla troca valvar mitro-aórtica (13,3%). A plastia valvar mitral representou 21% dos procedimentos mitrais. Acesso minimamente invasivo foi realizado em 1,6%. Ventilação mecânica invasiva no pós-operatório >24 horas ocorreu em 8,2%. As complicações pós-operatórias mais frequentes foram arritmias (22,6%) e infecções (5,7%), - ocorrendo em 27% no sítio cirúrgico. Cirurgias custeadas pelo sistema público – Sistema Único de Saúde representaram 80,8%. A mortalidade hospitalar foi de 7,3% enquanto o EuroSCORE Log médio de 7,9%. A etiopatogenia reumática ocorreu em 38,3% dos pacientes operados, enquanto a degenerativa senil aórtica em 13,2%. CONCLUSÃO: A cirurgia valvar isolada mais frequente no Brasil foi a troca valvar aórtica por acesso aberto convencional, seguida pela cirurgia de troca valvar mitral e a dupla troca valvar. A etiopatogenia mais comum encontrada ainda foi a reumática. A mortalidade das cirurgias cardíacas valvares no Brasil foi compatível com o risco cirúrgico estimado pelo EuroSCORE, evidenciando uma população de médio-alto risco cirúrgico operada no país. O registro BYPASS se tornou de fundamental importância para conhecermos o perfil dos pacientes com doença valvar em nosso país a fim de delinear estratégias adequadas para promoção de saúde e alocação de recursos para cirurgia cardíaca.Dados abertos - Sucupira - Teses e dissertações (2019

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

Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systemsand 7.3% from private (out-of-pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.Univ Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilHosp Caridade Sao Vicente Paulo, Jundiai, SP, BrazilInst Med Integral Prof Fernando Figueira IMIP, Recife, PE, BrazilHosp Base FUNFARME & FAMERP, Sao Jose Do Rio Preto, SP, BrazilIMC, Sao Jose Do Rio Preto, SP, BrazilIrmandade Santa Casa Sao Paulo INCT HPV, Fac Ciencias Med Santa Casa Sao Paulo, Sao Paulo, SP, BrazilFundacao Univ Cardiol, Inst Cardiol Rio Grande do Sul, Porto Alegre, RS, BrazilInst Coracao Natal, Natal, RN, BrazilInst Cardiol Dist Fed, Brasilia, DF, BrazilUniv Fed Maranhao HU UFMA, Univ Hosp, Sao Luis, MA, BrazilHosp Evangelico, Cachoeiro De Itapemirim, ES, BrazilHosp Coracao Sergipe, Aracaju, SE, BrazilHosp Nossa Senhora Salete, Inst Cirurgia Cardiovasc ICCV, Cascavel, PR, BrazilHosp Wilson Rosado, Mossoro, RN, BrazilHosp Bosque Saude, Sao Paulo, SP, BrazilHosp Univ Santa Maria, Santa Maria, RS, BrazilHosp Coracao HCor, Sao Paulo, SP, BrazilHosp Coracao IP HCor, Ins Pesquisa, Sao Paulo, SP, BrazilInst Coracao InCor, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilWeb of Scienc

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

Abstract 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

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

Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols