Contemporary outcomes of cardiac surgery patients supported by the intra-aortic balloon pump

OBJECTIVES: Although the intra-aortic balloon pump (IABP) has been the most widely adopted temporary mechanical support device in cardiac surgical patients, its use has declined. The current study aimed to evaluate the occurrence and predictors of early mortality and complication rates in contemporary cardiac surgery patients supported by an IABP.METHODS: A multicentre, retrospective analysis was performed of all consecutive cardiac surgical patients receiving perioperative balloon pump support in 8 centres between January 2010 to December 2019. The primary outcome was early mortality, and secondary outcomes were balloon-associated complications. A multivariable binary logistic regression model was applied to evaluate predictors of the primary outcome.RESULTS: The study cohort consisted of 2615 consecutive patients. The median age was 68 years [25th percentile 61, 75th percentile 75 years], with the majority being male (76.9%), and a mean calculated 30-day mortality risk of 10.0%. Early mortality was 12.7% (n = 333), due to cardiac causes (n = 266), neurological causes (=22), balloon-related causes (n = 5) and other causes (n = 40). A composite end point of all vascular complications occurred in 7.2% of patients, and leg ischaemia was observed in 1.3% of patients. The most important predictors of early mortality were peripheral vascular disease [odds ratio (OR) 1.63], postoperative dialysis requirement (OR 10.40) and vascular complications (OR 2.57).CONCLUSIONS: The use of the perioperative IABP proved to be safe and demonstrated relatively low complication rates, particularly for leg ischaemia. As such, we believe that specialists should not be held back to use this widely available treatment in high-risk cardiac surgical patients when indicated

Florística e fitossociologia da vegetação de um campo sujeito à arenização no sudoeste do Estado do Rio Grande do Sul, Brasil Floristics and phytosociology of grassland vegetation subject to sandy desertification in southwestern Rio Grande do Sul State, Brazil

Extensas áreas de campo nativo do sudoeste do Rio Grande do Sul são suscetíveis ao processo de arenização, que ocorre em áreas de fragilidade pedológica, tendo influência de interferência antrópica e fatores abióticos. Com o objetivo de testar a variação da cobertura vegetal e a dinâmica da arenização no tempo e conforme a influência da distância da encosta, foi desenvolvido um estudo florístico e fitossociológico em áreas de campo nativo sob pastejo. Duas subáreas, diferentes quanto ao processo da arenização, foram selecionadas no município de São Francisco de Assis, RS. O levantamento florístico apontou a ocorrência de 102 espécies, distribuídas em 25 famílias. No estudo fitossociológico, 35 quadros permanentes de 0,25 m² em cada subárea foram dispostos em diferentes distâncias da encosta do morro. Foram registradas as coberturas das espécies vegetais, do mantilho e do solo exposto em três períodos. Dados sobre riqueza e diversidade de espécies e formas de vida foram avaliados por análise de variância, via testes de aleatorização, considerando o fator temporal e o espacial (distância da encosta). Houve maior redução da diversidade específica e da cobertura vegetal na subárea 1 (com menor cobertura vegetal) conforme a variação temporal. Na subárea 2 (com maior cobertura vegetal), o aumento do solo exposto e a conseqüente redução da cobertura vegetal tiveram maior influência da distância da encosta. A alteração da cobertura vegetal e a expansão da arenização observadas ao longo do tempo são resultado da influência conjunta da dinâmica pluviométrica, do tipo solo, da presença de encostas dos relevos tabulares com pouca vegetação e da contínua pressão de pastejo.<br>Extensive areas of native grassland in southwestern Rio Grande do Sul are susceptible to sandy desertification, which occurs in pedologically fragile areas influenced by anthropic interference and abiotic factors. A floristic and phytosociological study was carried out in grazed native grasslands to test vegetation cover variation and sandy desertification dynamics over time and according to the influence of slope distance. Two sub-areas that differed as to the sandy desertification process were selected in São Francisco de Assis municipality, Rio Grande do Sul. The floristic survey revealed the presence of 102 species, distributed in 25 families. For the phytosociological study, 35 permanent plots (0.25 m² each) in each sub-area were arranged at different distances from the hillside slope. Cover of plant species and litter, and bare soil were recorded for three periods. Richness, species diversity, and life forms were evaluated by analysis of variance using randomization tests, considering temporal and spatial factors (slope distance). Higher reduction of species diversity and vegetation cover in sub-area 1 (with less vegetation cover) occurred due to temporal variation. In sub-area 2 (with more vegetation cover), the increase in bare soil and a subsequent reduction of vegetation cover were highly influenced by slope distance. Vegetation cover change and sandy desertification expansion observed throughout this period resulted from the joint influence of rainfall dynamics, soil type, presence of tableland slopes with little vegetation, and constant grazing pressure