Degree of risk related to procedures performed in conjunction with surgical myocardial revascularization in octogenarians

INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5%. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet),

Degree of risk related to procedures performed in conjunction with surgical myocardial revascularization in octogenarians

INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5%. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45%. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, and postoperative need for prolonged respiratory support

Correlação do grau da estenose aórtica (EAo) com a massa do ventrículo esquerdo (ve)

Fundamentos: há três décadas Rapaport destacou o risco de morte súbita nos portadores de EAo a ponto de recomendar a interrupção mais precoce da evolução natural como forma de prevenção. O objetivo foi estabelecer o perfil dos portadores de EAo e identificar os fatores que contribuíram para o aumento da massa do VE. Casuística: a população fonte contou com 79 portadores de EAo, estratificados, sendo o grupo (G1) constituído pelos pacientes com gradiente VE-AO<50 mm Hg e o (G2) constituído pelos pacientes com gradiente => 50 mmHg. Metodologia: estudo transversal contendo 15 variáveis. Análise uni e multivariada. Nível de significância de 5%. Aprovado pelo Comitê de Ética. Resultados: o G1 ficou constituído por 50 pacientes: 25 (32%) do sexo feminino (sf), 25 (32%) do masculino (sm); idade média igual 63,87±14,44 anos; e o G2 por 29 pacientes: 12 (15%) do sf e 17 (22%) do sm, com média de idade de 60,39±18,61. A análise univariada evidenciou: sexo (p=0,491), massa do VE (P=0,078), gradiente transaórtico max. (p=0,000); dimensões: diástole (P=0,855), sístole (P=0,520), septo interventricular (P=0,006), parede posterior (p=0,016), fração de ejeção (p=0,237), delta D% (P=0,131), aorta (P=0,153), átrio esquerdo (P=0,646) e ritmo cardíaco (P=0,885). Conclusão: em nosso meio, o portador de EAo é um paciente idoso (62,64±15,93 anos), com predominância para o sm 1,13/1 e, à medida que o gradiente transvalvar aumenta, ocorre um aumento na massa do VE que foi atribuída à idade (4,49%), à parede posterior (46,48%) e à espessura do septo (49,84%). Auxílio: PIBIC - CEPE