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1.
Ann Card Anaesth ; 27(1): 37-42, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38722119

RESUMO

INTRODUCTION: The aim of this study was to evaluate the prediction of vasoactive inotropic score (VIS) on early mortality and morbidity after coronary artery bypass grafting (CABG) and to determine the ideal time for score calculation. MATERIALS AND METHODS: The study included patients who underwent isolated on-pump CABG surgery between November 2021 and November 2022. Pre, intra, and postoperative data were obtained by retrospective chart review. The final VIS value in the operating room (VISintra) and the highest VIS value in the first 24 hours in the intensive care unit (VISmax) were calculated. The patients were divided into two groups; Group 1 who developed early postoperative morbidity and mortality and Group 2 who did not. And the data were analyzed by groups. RESULTS: A total of 221 patients with a mean age of 63.49 ± 9.96 years were evaluated and 73 (33%) were in Group 1. The cut-off value for VISintra was determined to be 6.20, VISmax was 6,05. VISintra and VISmax values were significantly higher in the poor outcome group. Multivariate analysis showed that only VISmax value was an independent variable on mortality-morbidity. CONCLUSIONS: Our results imply that the vasoactive inotropic score is an easy and inexpensive score to calculate and can be used as a specific scoring system to predict poor early outcomes in CABG patients. According to statistical analyses, the most predictive time among VIS measurements was VISmax, the highest value calculated in the ICU in the first 24 hours postoperatively.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/epidemiologia , Idoso , Ponte de Artéria Coronária/mortalidade , Procedimentos Cirúrgicos Cardíacos , Fatores de Tempo , Valor Preditivo dos Testes , Morbidade
2.
EuroIntervention ; 20(9): 561-570, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38726719

RESUMO

BACKGROUND: Vessel-level physiological data derived from pressure wire measurements are one of the important determinant factors in the optimal revascularisation strategy for patients with multivessel disease (MVD). However, these may result in complications and a prolonged procedure time. AIMS: The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated. METHODS: Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen's kappa. RESULTS: The trial included 248 patients with MVD from 10 study sites. Cohen's kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and CABG were substantial for both revascularisation modes (Cohen's kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen's kappa=0.95 [95% CI:0.90-1.00]). CONCLUSIONS: QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.


Assuntos
Angiografia Coronária , Doença da Artéria Coronariana , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Humanos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Feminino , Masculino , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Idoso , Ponte de Artéria Coronária/métodos , Tomada de Decisão Clínica , Cateterismo Cardíaco/métodos , Equipe de Assistência ao Paciente
3.
Open Heart ; 11(1)2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724266

RESUMO

OBJECTIVES: Myocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies. However, there is uncertainty about whether this translates into clinical benefits because of the coadministration of propofol and its detrimental effects, restricting myocardial protective processes. METHODS: In this single-blinded, parallel-group randomised controlled feasibility trial, higher-risk patients undergoing elective coronary artery bypass graft (CABG) surgery with an additive European System for Cardiac Operative Risk Evaluation ≥5 were randomised to receive either propofol or total inhalational anaesthesia as single agents for maintenance of anaesthesia. The primary outcome was the feasibility of recruiting and randomising 50 patients across two cardiac surgical centres, and secondary outcomes included the feasibility of collecting the planned perioperative data, clinically relevant outcomes and assessments of effective patient identification, screening and recruitment. RESULTS: All 50 patients were recruited within 11 months in two centres, allowing for a 13-month hiatus in recruitment due to the COVID-19 pandemic. Overall, 50/108 (46%) of eligible patients were recruited. One patient withdrew before surgery and one patient did not undergo surgery. All but one completed in-hospital and 30-day follow-up. CONCLUSIONS: It is feasible to recruit and randomise higher-risk patients undergoing CABG surgery to a study comparing total inhalational and propofol anaesthesia in a timely manner and with high acceptance and completion rates. TRIAL REGISTRATION NUMBER: NCT04039854.


Assuntos
Anestésicos Intravenosos , Ponte de Artéria Coronária , Estudos de Viabilidade , Propofol , Humanos , Propofol/administração & dosagem , Propofol/efeitos adversos , Masculino , Feminino , Projetos Piloto , Idoso , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Pessoa de Meia-Idade , Método Simples-Cego , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Anestesia por Inalação/métodos , Anestesia por Inalação/efeitos adversos , Resultado do Tratamento , Medição de Risco/métodos , Fatores de Risco , COVID-19/epidemiologia , COVID-19/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos
4.
Scand Cardiovasc J ; 58(1): 2347297, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38695238

RESUMO

Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p < .001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p < .001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1-354.9, p < .001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge.


Assuntos
Fibrilação Atrial , Ponte de Artéria Coronária , Intervenção Coronária Percutânea , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/etiologia , Estudos Prospectivos , Intervenção Coronária Percutânea/efeitos adversos , Masculino , Incidência , Feminino , Ponte de Artéria Coronária/efeitos adversos , Idoso , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/diagnóstico , Frequência Cardíaca , Angina Estável/diagnóstico , Angina Estável/fisiopatologia , Angina Estável/epidemiologia , Angina Estável/cirurgia , Angina Estável/terapia , Medição de Risco , Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Síndrome Coronariana Aguda/epidemiologia , Telemetria
7.
Braz J Cardiovasc Surg ; 39(4): e20230270, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748989

RESUMO

INTRODUCTION: Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential. OBJECTIVE: To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting. METHODS: This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software. RESULTS: A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF. CONCLUSION: POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality.


Assuntos
Fibrilação Atrial , Ponte de Artéria Coronária , Complicações Pós-Operatórias , Humanos , Fibrilação Atrial/etiologia , Fibrilação Atrial/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Masculino , Feminino , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Brasil/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Incidência , Tempo de Internação , Mortalidade Hospitalar , Pontuação de Propensão , Estudos Prospectivos
8.
Braz J Cardiovasc Surg ; 39(4): e20230303, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38749004

RESUMO

INTRODUCTION: In this study, we aimed to evaluate the most common causes of recurrent angina after coronary artery bypass grafting (CABG) and our treatment approaches applied in these patients. METHODS: We included all patients who underwent CABG, with or without percutaneous coronary intervention after CABG, at our hospital from September 2013 to December 2019. Patients were divided into two groups according to the time of onset of anginal pain after CABG. Forty-five patients (58.16 ± 8.78 years) had recurrent angina in the first postoperative year after CABG and were specified as group I (early recurrence). Group II (late recurrence) comprised 82 patients (58.05 ± 8.95 years) with angina after the first year of CABG. RESULTS: The mean preoperative left ventricular ejection fraction was 53.22 ± 8.87% in group I, and 54.7 ± 8.58% in group II (P=0.38). No significant difference was registered between groups I and II regarding preoperative angiographic findings (P>0.05). Failed grafts were found in 27.7% (n=28/101) of the grafts in group I as compared to 26.8% (n=51/190) in group II (P>0.05). Twenty-four (53.3%) patients were treated medically in group I, compared with 54 (65.8%) patients in group II (P=0.098). There was a need for intervention in 46.6% (n=21) of group I patients, and in 34.1% (n=28) of group II patients. CONCLUSION: Recurrent angina is a complaint that should not be neglected because most of the patients with recurrent angina are diagnosed with either native coronary or graft pathology in coronary angiography performed.


Assuntos
Angina Pectoris , Ponte de Artéria Coronária , Recidiva , Humanos , Ponte de Artéria Coronária/efeitos adversos , Pessoa de Meia-Idade , Masculino , Feminino , Angina Pectoris/etiologia , Angina Pectoris/cirurgia , Idoso , Estudos Retrospectivos , Angiografia Coronária , Complicações Pós-Operatórias/etiologia , Intervenção Coronária Percutânea , Resultado do Tratamento , Fatores de Tempo , Volume Sistólico/fisiologia
9.
Braz J Cardiovasc Surg ; 39(4): e20230154, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748974

RESUMO

INTRODUCTION: It is not yet clear whether cardiac surgery by mini-incision (minimally invasive cardiac surgery [MICS]) is overall less painful than the conventional approach by full sternotomy (FS). A meta-analysis is necessary to investigate polled results on this topic. METHODS: PubMed®/MEDLINE, Cochrane CENTRAL, Latin American and Caribbean Health Sciences Literature (or LILACS), and Scientific Electronic Library Online (or SciELO) were searched for all clinical trials, reported until 2022, comparing FS with MICS in coronary artery bypass grafting (CABG), mitral valve surgery (MVS), and aortic valve replacement (AVR), and postoperative pain outcome was analyzed. Main summary measures were the method of standardized mean differences (SMD) with a 95% confidence interval (CI) and P-values (considered statistically significant when < 0.05). RESULTS: In AVR, the general estimate of postoperative pain effect favored MICS (SMD 0.87 [95% CI 0.04 to 1.71], P=0.04). However, in the sensitivity analysis, there was no difference between the groups (SMD 0.70 [95% CI -0.69 to 2.09], P=0.32). For MVS, it was not possible to perform a meta-analysis with the included studies, because they had different methodologies. In CABG, the general estimate of the effect of postoperative pain did not favor any of the approaches (SMD -0.40 [95% CI -1.07 to 0.26], P=0.23), which was confirmed by sensitivity analysis (SMD -0.02 [95% CI -0.71 to 0.67], P=0.95). CONCLUSION: MICS was not globally less painful than the FS approach. It seems that postoperative pain is more related to the degree of tissue retraction than to the size of the incision.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte de Artéria Coronária , Procedimentos Cirúrgicos Minimamente Invasivos , Dor Pós-Operatória , Esternotomia , Humanos , Esternotomia/efeitos adversos , Esternotomia/métodos , Dor Pós-Operatória/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos
10.
Artigo em Inglês | MEDLINE | ID: mdl-38695663

RESUMO

A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.


Assuntos
Dissecção Aórtica , Ponte de Artéria Coronária , Átrios do Coração , Humanos , Masculino , Idoso , Átrios do Coração/cirurgia , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Fístula Vascular/cirurgia , Fístula Vascular/etiologia , Fístula Vascular/diagnóstico , Fístula/cirurgia , Fístula/etiologia , Fístula/diagnóstico , Reoperação/métodos , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Veia Safena/transplante
11.
Diab Vasc Dis Res ; 21(3): 14791641241253540, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38710662

RESUMO

This case challenges the conventional preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in patients with diabetes, left main coronary artery disease (LMCAD) and multivessel disease. Current guidelines generally recommend CABG, especially in the context of LMCAD. However, our case involves a male patient with diabetes with LMCAD and extensive multivessel disease who was successfully treated with PCI, demonstrating a favorable outcome. Despite the high-risk profile, including a SYNTAX score of 28, the PCI approach was selected. This decision was supported by evidence suggesting comparable outcomes between PCI and CABG in similar patients. Our case highlights the potential of PCI as not just a viable, but potentially superior alternative in specific high-risk patients with diabetes, contrary to the prevailing belief in favor of CABG for all patients with left main involvement.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Humanos , Masculino , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/complicações , Resultado do Tratamento , Fatores de Risco , Tomada de Decisão Clínica , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Idoso , Angiografia Coronária , Seleção de Pacientes , Medição de Risco , Pessoa de Meia-Idade
12.
World J Surg Oncol ; 22(1): 119, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38702732

RESUMO

BACKGROUND: Coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) is a well-established, safe procedure. However, problems with RGEA grafts in subsequent abdominal surgeries can lead to fatal complications. This report presents the first case of right hepatectomy for hepatocellular carcinoma after CABG using the RGEA. CASE PRESENTATION: We describe a case in which a right hepatectomy for an 81-year-old male patient with hepatocellular carcinoma was safely performed after CABG using a RGEA graft. Preoperatively, three-dimensional computed tomography (3D- CT) images were constructed to confirm the run of the RGEA graft. The operation was conducted with the standby of a cardiovascular surgeon if there was a problem with the RGEA graft. The RGEA graft had formed adhesions with the hepatic falciform ligament, necessitating meticulous dissection. After the right hepatectomy, the left hepatic lobe descended into the vacated space, exerting traction on the RGEA. However, this traction was mitigated by suturing the hepatic falciform ligament to the abdominal wall, ensuring stability of the RGEA. There were no intraoperative or postoperative complications. CONCLUSION: It is crucial to confirm the functionality and anatomy of the RGEA graft preoperatively, handle it gently intraoperatively, and collaborate with cardiovascular surgeons.


Assuntos
Carcinoma Hepatocelular , Ponte de Artéria Coronária , Artéria Gastroepiploica , Hepatectomia , Neoplasias Hepáticas , Humanos , Masculino , Artéria Gastroepiploica/cirurgia , Hepatectomia/métodos , Idoso de 80 Anos ou mais , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/patologia , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/patologia , Ponte de Artéria Coronária/métodos , Tomografia Computadorizada por Raios X , Prognóstico , Imageamento Tridimensional , Complicações Pós-Operatórias/cirurgia
13.
J Cardiothorac Surg ; 19(1): 274, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38702789

RESUMO

BACKGROUND: To evaluate the clinical efficacy and safety of intraoperative intravenous amiodarone for arrhythmia prevention in on-pump coronary artery bypass grafting (CABG) patients. METHODS: A meta-analysis of randomized controlled trials was conducted. Pubmed, Embase, Cochrane Library, Ovid, China National Knowledge Infrastructure, and the Wan Fang database until July 1th, 2023. The primary outcomes of interest included the incidences of intra- and post-operative atrial fibrillation (POAF), ventricular fibrillation, or any arrhythmia, including atrial fibrillation, ventricular fibrillation, ventricular tachycardia, premature ventricular contraction, and sinus bradycardia. For continuous and dichotomous variables, treatment effects were calculated as the weighted mean difference (WMD)/risk ratio (RR) and 95% confidence interval (CI). RESULTS: A database search yielded 7 randomized controlled trials including 608 patients, where three studies, including three treatments (amiodarone, lidocaine, and saline), contributed to the clinical outcome of atrial fibrillation, ventricular fibrillation, or any arrhythmia. Meta-analysis demonstrated that amiodarone can significantly reduce the incidence of POAF (RR, 0.39; 95%CI: 0.20, 0.77; P = 0.007, I2 = 0%) in patients undergoing on-pump CABG; there was no statistically significant influence on intra-operative atrial fibrillation, intra- and post-operative ventricular fibrillation, or any arrhythmia. CONCLUSIONS: The current study suggests that intraoperative administration of intravenous amiodarone may be safe and effective in preventing POAF in patients undergoing on-pump CABG. More well-designed clinical trials are needed to validate this result.


Assuntos
Amiodarona , Antiarrítmicos , Ponte de Artéria Coronária , Humanos , Amiodarona/administração & dosagem , Amiodarona/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Antiarrítmicos/administração & dosagem , Antiarrítmicos/efeitos adversos , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/prevenção & controle , Cuidados Intraoperatórios/métodos , Administração Intravenosa , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Braz J Cardiovasc Surg ; 39(3): e20230218, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748809

RESUMO

INTRODUCTION: This study aimed to investigate the predictive value of the vasoactive-inotropic score (VIS) at different time points for postoperative prolonged mechanical ventilation (PMV) in adult congenital heart disease patients undergoing surgical treatment combined with coronary artery bypass grafting. METHODS: Patients were divided into two groups that developed PMV or not. The propensity score matching method was applied to reduce the effects of confounding factors between the two groups. VIS at different time points (VIS at the end of surgery, VIS6h, VIS12h, and VIS12h max) after surgery were recorded and calculated. The value of VIS in predicting PMV was analyzed by the receiver operating characteristic (ROC) curve, and multivariate logistic regression was used to analyze independent risk factors. RESULTS: Among 250 patients, 52 were in the PMV group, and 198 were in the non-PMV group. PMV rate was 20.8%. After propensity score matching, 94 patients were matched in pairs. At each time point, the area under the ROC curve predicted by VIS for PMV was > 0.500, among which VIS at the end of surgery was the largest (0.805). The optimal cutoff point for VIS of 6.5 could predict PMV with 78.7% sensitivity and 72.3% specificity. VIS at the end of surgery was an independent risk factor for PMV (odds ratio=1.301, 95% confidence interval 1.091~1.551, P<0.01). CONCLUSION: VIS at the end of surgery is an independent predictor for PMV in patients with adult congenital heart disease surgical treatment combined with coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária , Cardiopatias Congênitas , Pontuação de Propensão , Curva ROC , Respiração Artificial , Humanos , Ponte de Artéria Coronária/métodos , Feminino , Masculino , Cardiopatias Congênitas/cirurgia , Adulto , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Estudos Retrospectivos , Valor Preditivo dos Testes , Período Pós-Operatório , Modelos Logísticos
15.
Braz J Cardiovasc Surg ; 39(3): e20230366, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748866

RESUMO

INTRODUCTION: Although there are publications in the literature stating that parameters related to the nutritional status of patients are associated with the clinical outcomes of those with coronary artery disease, it is also stated that there is insufficient data on the relationship between nutritional indices and long-term outcomes and major adverse cardiovascular events in patients undergoing isolated coronary artery bypass grafting. METHODS: This retrospective study was conducted with patients who underwent isolated elective on-pump coronary artery bypass grafting in our hospital. Patients who underwent emergency coronary artery bypass grafting or those with known atrial fibrillation in the preoperative period were excluded. Patients were analyzed and compared in two groups according to the development of postoperative atrial fibrillation. RESULTS: The data of 93 coronary artery bypass grafting patients (71 [76%] males) with a mean age of 62.86 ± 9.53 years included in the study were evaluated. Both groups had similar preoperative ejection fraction value, hemoglobin level, age, number of distal bypasses, and postoperative mortality rates. Although the mean cardiopulmonary bypass and aortic cross-clamping times were higher in Group 1, they were not statistically significant. In our study, the mean prognostic nutrition index value was 51.76 ± 3002. CONCLUSION: According to our study results, there was no statistically significant difference between prognostic nutrition index values and the development of atrial fibrillation after coronary artery bypass grafting, which is similar to some publications in the literature. We think that it would be beneficial to conduct randomized studies involving more patients on this subject.


Assuntos
Fibrilação Atrial , Ponte de Artéria Coronária , Estado Nutricional , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos , Ponte de Artéria Coronária/efeitos adversos , Masculino , Fibrilação Atrial/etiologia , Feminino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Idoso , Contagem de Linfócitos , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Doença da Artéria Coronariana/cirurgia , Fatores de Risco , Fatores de Tempo , Valores de Referência
16.
A A Pract ; 18(5): e01785, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38727098

RESUMO

This case series describes the safety and effectiveness of superficial parasternal intercostal plane catheters for poststernotomy pain control in 4 patients who underwent multivessel coronary artery bypass grafting. Patients had reduced sternal pain and opioid consumption while the catheters ran continuously for 72 hours without complications. Our experience suggests the effectiveness of parasternal blocks can be safely prolonged with catheters, and they can be a useful addition to pain management strategies for this patient population.


Assuntos
Bloqueio Nervoso , Dor Pós-Operatória , Esternotomia , Humanos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Bloqueio Nervoso/métodos , Bloqueio Nervoso/instrumentação , Manejo da Dor/métodos , Ponte de Artéria Coronária/métodos , Catéteres
17.
Rev Assoc Med Bras (1992) ; 70(5): e20240076, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38775517

RESUMO

OBJECTIVE: Inflammation plays a key role in the pathogenesis of postoperative atrial fibrillation after coronary artery bypass graft surgery. In this study, we aimed to investigate the changes in mean platelet volume and platelet values during the spring and autumn seasons in patients who underwent isolated coronary artery bypass graft surgery and the possible effect of these occurrences on postoperative atrial fibrillation. METHODS: Consecutive patients who underwent elective isolated coronary bypass surgery at our clinic in the spring and autumn months, between August 2020 and July 2022, were retrospectively included in this study. Variables were evaluated according to the spring and autumn seasons. Patients who did not develop in-hospital postoperative atrial fibrillation were identified as Group 1, and those who did constituted Group 2. RESULTS: A total of 622 patients were included in the study. The patients were divided into two groups: those who were operated on in the spring (n=277, median age=62 years, male gender ratio=77.3%) and those who were operated on in the autumn (n=345, median age=61 years, male gender ratio=81.4%). There was no statistically significant difference between the patients operated on in both seasons in terms of age, gender, hypertension rates, and the frequency of chronic obstructive pulmonary disease. In multivariate analysis, being over 70 years old (OR: 1.934, 95% confidence interval (CI) 1.489-2.995, p<0.001), having a left ventricular ejection fraction below 30% (OR: 1.550, 95%CI 1.190-2.236, p=0.012), and having chronic obstructive pulmonary disease (OR: 1.663, 95%CI 1.339-2.191, p<0.001) were found to be independent predictors in predicting the development of postoperative atrial fibrillation. CONCLUSION: In this study, we first demonstrated that mean platelet volume and platelet mass index values were higher in patients in the autumn months. Additionally, for the first time in the literature, we showed that there is a significant relationship between platelet mass index value and the development of postoperative atrial fibrillation in patients who underwent isolated coronary artery bypass graft.


Assuntos
Fibrilação Atrial , Ponte de Artéria Coronária , Volume Plaquetário Médio , Complicações Pós-Operatórias , Estações do Ano , Humanos , Fibrilação Atrial/etiologia , Masculino , Feminino , Ponte de Artéria Coronária/efeitos adversos , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Contagem de Plaquetas , Plaquetas
18.
Sci Rep ; 14(1): 11373, 2024 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-38762564

RESUMO

There are some discrepancies about the superiority of the off-pump coronary artery bypass grafting (CABG) surgery over the conventional cardiopulmonary bypass (on-pump). The aim of this study was estimating risk ratio of mortality in the off-pump coronary bypass compared with the on-pump using a causal model known as collaborative targeted maximum likelihood estimation (C-TMLE). The data of the Tehran Heart Cohort study from 2007 to 2020 was used. A collaborative targeted maximum likelihood estimation and targeted maximum likelihood estimation, and propensity score (PS) adjustment methods were used to estimate causal risk ratio adjusting for the minimum sufficient set of confounders, and the results were compared. Among 24,883 participants (73.6% male), 5566 patients died during an average of 8.2 years of follow-up. The risk ratio estimates (95% confidence intervals) by unadjusted log-binomial regression model, PS adjustment, TMLE, and C-TMLE methods were 0.86 (0.78-0.95), 0.88 (0.80-0.97), 0.88 (0.80-0.97), and 0.87(0.85-0.89), respectively. This study provides evidence for a protective effect of off-pump surgery on mortality risk for up to 8 years in diabetic and non-diabetic patients.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Humanos , Masculino , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Feminino , Pessoa de Meia-Idade , Idoso , Funções Verossimilhança , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Irã (Geográfico)/epidemiologia , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/mortalidade , Resultado do Tratamento , Pontuação de Propensão , Ponte Cardiopulmonar/efeitos adversos
19.
Mymensingh Med J ; 33(2): 516-525, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38557535

RESUMO

Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. History of a ST-elevation myocardial infarction (STEMI) is considered an independent risk factor for CABG irrespective of timing for an emergency or elective surgery. Patients with STEMI are candidates for both On-pump and Off-pump CABG procedures. This paper discusses the possible best option for elective surgical revascularization in patients with prior STEMI. This prospective clinical trial of 60 eligible patients with prior STEMI was conducted in a Tertiary Care Hospital from April 2018 to March 2019. Among them, 30 patients underwent off-pump (Group A) and 30 patients underwent on-pump (Group B) CABG procedures. Outcomes between both groups were observed from surgery to 1 month postoperatively. Data was analysed by the software statistical program for social science (SPSS 25.0 Inc). The surgery was successful in both groups of patients. Differences were observed by mean number of grafts per patient (2.77±0.43 vs. 3.10±0.71) and duration of operation (4.41±0.35 hours vs. 5.71±0.48 hours). An improvement in Left Ventricular Ejection Fraction (LVEF %) was observed in both groups postoperatively (17.98% vs. 10.98%) and the postoperative LVEF% at different time points were found statistically significant (p<0.05) over preoperative LVEF%. Multivariable stepwise logistic regression analysis correlated on-pump CABG with prolonged need for ionotropic support, need for blood transfusion, longer hospital stay and less improvement in LVEF%. The study supports the Off-pump CABG as a better surgical option over on-pump CABG in patients with prior STEMI.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico , Função Ventricular Esquerda , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Resultado do Tratamento
20.
J Pak Med Assoc ; 74(3): 528-533, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38591292

RESUMO

Objective: To assess the combined impact of interval training programme on haemodynamic variables, specifically blood pressure and heart rate, in patients having undergone coronary artery bypass graft surgery. METHODS: The meta-analysis was conducted from October to December 2022, and comprised search on PubMed, MEDLINE, Web of Science, PeDro, EMBASE, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar and Scopus electronic databases by two researchers independently for literature published between 2009 and 2020 related to the effects of interval training on coronary artery bypass graft patients. Meta-analysis was then performed to analyse the effects of an interval training on systolic blood pressure, diastolic blood pressure, and heart rate. The meta-analysis was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS: Of the 122 studies initially located, 7 were related to the effects of different forms of interval trainings and their impact on systolic and diastolic blood pressure of the patients, and 5 studies analysing the effects of interval trainings on heart rate. Interval training showed mild improvement in decreasing SBP compared to control groups. Standardized mean difference suggested an effect size of -0.226 in random effect model (I2=52.01; p=0.064). Similarly, a small effect size of 0.136 (I2=39.19%, p=0.14) was observed for diastolic blood pressure. Also, there was a small effect size of 0.155 (I2= 28.08, p=0.23) observed for heart rate. Conclusion: Interval training programmes, including high-intensity interval training, low-volume interval training, and aerobic interval training, had a small effect on systolic blood pressure, whereas continuous training protocols had a similarly small effect size on diastolic blood pressure and heart rate.


Assuntos
Ponte de Artéria Coronária , Treinamento Intervalado de Alta Intensidade , Humanos , Pressão Sanguínea , Frequência Cardíaca
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