RESUMO
OBJECTIVES: To compare and validate the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with EuroSCORE at our institution. METHODS: The logistic EuroSCORE and EuroSCORE II were calculated on the entire patient cohort undergoing major cardiac surgery at our centre between January 2005 and December 2010. The goodness of fit was compared by means of the Hosmer-Lemeshow (HL) chi-squared test and the area under the curve (AUC) of the receiver operating characteristic curves of both scales applied to the same sample of patients. These analyses were repeated and stratified by the type of surgery. RESULTS: Mortality of 5.66% was observed, with estimated mortalities according to logistic EuroSCORE and EuroSCORE II of 9 and 4.46%, respectively. The AUC for EuroSCORE (0.82, 95% confidence interval [CI] 0.79-0.85) was lower than that for EuroSCORE II (0.85, 95% CI 0.83-0.87) without the differences being statistically significant (P = 0.056). Both scales showed a good discriminative capacity for all the pathologies subgroups. The two scales showed poor calibration in the sample: EuroSCORE (χ(2) = 39.3, P(HL) < 0.001) and EuroSCORE II (χ(2) = 86.69, P(HL) < 0.001). The calibration of EuroSCORE was poor in the groups of patients undergoing coronary (P(HL) = 0.01), valve (P(HL) = 0.01) and combined coronary valve surgery (P(HL) = 0.012); and that of EuroSCORE II in the group of coronary (P(HL) = 0.001) and valve surgery (P(HL) < 0.001) patients. CONCLUSIONS: EuroSCORE II demonstrated good discriminative capacity and poor calibration in the patients undergoing major cardiac surgery at our centre.
Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Técnicas de Apoio para a Decisão , Idoso , Área Sob a Curva , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Distribuição de Qui-Quadrado , Análise Discriminante , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha , Resultado do TratamentoAssuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Idoso , Ecocardiografia Tridimensional , Evolução Fatal , Humanos , Masculino , Valva Mitral/patologia , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Falha de TratamentoRESUMO
An 83-year-old patient underwent a transapical aortic valve implantation at our institution. Four months later, she was readmitted to our institution because of fever and heart failure. A prosthetic aortic valve endocarditis was diagnosed. Because of the high surgical risk, surgery was refused and the patient died shortly after the diagnosis. We briefly discuss the implications of this finding in the prevention of infective endocarditis after transcatheter aortic valve implantation.
Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/efeitos adversos , Endocardite Bacteriana/microbiologia , Enterococcus faecalis/isolamento & purificação , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cateterismo Cardíaco/instrumentação , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do Tratamento , UltrassonografiaAssuntos
Ruptura Cardíaca/microbiologia , Hemorragia/microbiologia , Mediastinite/microbiologia , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Antibacterianos/uso terapêutico , Drenagem , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/terapia , Ventrículos do Coração/microbiologia , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Técnicas Hemostáticas , Humanos , Mediastinite/diagnóstico por imagem , Mediastinite/terapia , Radiografia , Reoperação , Deiscência da Ferida Operatória/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/terapia , Técnicas de Sutura , Resultado do TratamentoRESUMO
Pregnant women with a mechanical heart prosthesis are at a higher risk of thromboembolic complications. The optimal anticoagulation strategy in this setting remains unclear. When prosthesis thrombosis happens and cardiac surgery must be performed, the risk of fetal mortality is high. Special attention must be paid to improve the placental perfusion during cardiopulmonary bypass (CPB) in order to improve fetal outcomes. A 31-year-old woman, nine weeks pregnant, was admitted to our institution due to a mitral mechanical prosthesis thrombosis. She had been receiving low molecular weight heparin (LMWH) since pregnancy was detected. She underwent a mitral valve replacement with CPB at 34 degrees C and a short cardiac arrest time. Both mother and fetus survived. We briefly review the different anticoagulation options during pregnancy and perfusion strategies on CPB to improve fetal outcomes.
