ABSTRACT
INTRODUÇÃO: Novos fármacos e procedimentos percutâneos têm modificado a evolução da doença aterosclerótica coronariana. Estudos recentes demonstraram importantes modificações nas estratégias terapêuticas. Durante a pandemia de Covid-19 houve uma significativa redução dos procedimentos cirúrgicos. Neste cenário, a lista cirúrgica para revascularização do miocárdio foi reavaliada por um Heart Team (HT), consistindo em clínicos, hemodinamicistas e cirurgiões, todos seniors. MÉTODOS: Estudo observacional descritivo de pacientes incluídos em uma lista de cirurgia de revascularização do miocárdio (CRM) em Hospital Terciário de Cardiologia que, após revisão do caso por HT, tiveram a conduta modificada para tratamento clínico ou intervenção coronária percutânea (ICP). RESULTADOS: Dos 157 pacientes originalmente incluídos em fila cirúrgica, 29 pacientes (18%) tiveram sua estratégia terapêutica modificada, sendo 12 para tratamento clínico e 17 para tratamento percutâneo. A idade média dos pacientes foi 65,6 anos, sendo 66 anos no grupo clínico e 62,2 anos no gruposubmetido à ICP. 72% eram do sexo masculino, 86% eram hipertensos, 62% diabéticos, 17% tinham doença renal crônica, 51% com história de tabagismo e 20% eram obesos. 65% tinham história de Infarto Agudo do Miocárdio e 13% já haviam sido submetidos à angioplastia coronária. A fração de ejeção de ventrículo esquerdo média foi 51,6%. 27% eram assintomáticos, 27,6% referiam angina CCS 1 ou 2, e 33% dispneia NYHA I ou II. 44% das indicações de CRM iniciais foram realizadas por um único cardiologista assistente. Discussão: Pacientes com anatomia passível e graves lesões coronarianas tiveram sua estratégia terapêutica modificada para ICP. Pacientes pouco sintomáticos ou de elevado risco cirúrgico foram mantidos em tratamento clínico. Estes pacientes terão acompanhamento específico como parte deste estudo. A maior parte (82%) dos pacientes mantiveram a indicação cirúrgica, baseado em complexidade anatômica e sintomatologia. A impossibilidade de realização de CRM devido a pandemia trouxe grandes desafios na tomada de decisão destes pacientes de alto risco. CONCLUSÃO: A reavaliação da fila de CRM por HT, baseado nas atuais evidências permitiu a redução do número de indicações de CRM para pacientes com DAC complexa. O seguimento desses pacientes fornecera informações relevantes sobre modificações de estratégias terapêuticas.
Subject(s)
Coronary Artery Disease/surgery , Waiting Lists , Myocardial Revascularization , COVID-19ABSTRACT
COVID-19 caused by the novel coronavirus SARS-CoV-2 led to the pandemic, causing unprecedented health and social crisis worldwide. Acute coronary syndromes patients, especially when coronary artery bypass graft (CABG) surgery is needed, may present with higher severity risk if affected by COVID-19. Extracorporeal circulation leads to activation of endothelium and microcirculatory network, which activates the coagulation, platelet aggregation and inflammation 1. COVID-19 may also course with severe inflammation, massive secretion of inflammatory cytokines, plaque rupture and a procoagulant state 2. Therefore, it is advisable to postpone surgeries interventions when possible. However, our institution is a public tertiary referral hospital for high-risk cardiovascular patients even in SARS-CoV-2 pandemic. We describe a series of thirteen high risk coronary artery disease patients submitted to CABG and who had COVID-19 infection during the same hospitalization, six patients had COVID-19 before surgery, three patients were operated with active infection and four patients were infected after surgery
Subject(s)
Coronary Artery Disease , Coronary Artery Bypass , Cytokines , Coronavirus , Acute Coronary SyndromeSubject(s)
COVID-19/diagnosis , Coronary Artery Bypass , Coronary Artery Disease/surgery , Adult , Aged , COVID-19/mortality , COVID-19/prevention & control , COVID-19/transmission , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/mortality , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/mortality , Female , Hospital Mortality , Humans , Infection Control , Male , Middle Aged , Postoperative Complications/mortality , Risk Assessment , Risk Factors , Time Factors , Time-to-Treatment , Treatment OutcomeABSTRACT
OBJECTIVE: To assess mortality and the psychological repercussions of the prolonged waiting time for candidates for heart surgery. METHODS: From July 1999 to May 2000, using a standardized questionnaire, we carried out standardized interviews and semi-structured psychological interviews with 484 patients with coronary heart disease, 121 patients with valvular heart diseases, and 100 patients with congenital heart diseases. RESULTS: The coefficients of mortality (deaths per 100 patients/year) were as follows: patients with coronary heart disease, 5.6; patients with valvular heart diseases, 12.8; and patients with congenital heart diseases, 3.1 (p<0.0001). The survival curve was lower in patients with valvular heart diseases than in patients with coronary heart disease and congenital heart diseases (p<0.001). The accumulated probability of not undergoing surgery was higher in patients with valvular heart diseases than in the other patients (p<0.001), and, among the patients with valvular heart diseases, this probability was higher in females than in males (p<0.01). Several patients experienced intense anxiety and attributed their adaptive problems in the scope of love, professional, and social lives, to not undergoing surgery. CONCLUSION: Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions.
Subject(s)
Heart Diseases/mortality , Waiting Lists , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Cardiac Surgical Procedures , Coronary Disease/mortality , Coronary Disease/psychology , Coronary Disease/surgery , Female , Heart Defects, Congenital/mortality , Heart Defects, Congenital/psychology , Heart Diseases/psychology , Heart Valve Diseases/mortality , Heart Valve Diseases/psychology , Humans , Interviews as Topic , Male , Middle Aged , Myocardial Revascularization , Survival Analysis , Time FactorsABSTRACT
OBJECTIVE - To assess mortality and the psychological repercussions of the prolonged waiting time for candidates for heart surgery. METHODS - From July 1999 to May 2000, using a standardized questionnaire, we carried out standardized interviews and semi-structured psychological interviews with 484 patients with coronary heart disease, 121 patients with valvular heart diseases, and 100 patients with congenital heart diseases. RESULTS - The coefficients of mortality (deaths per 100 patients/year) were as follows: patients with coronary heart disease, 5.6; patients with valvular heart diseases, 12.8; and patients with congenital heart diseases, 3.1 (p<0.0001). The survival curve was lower in patients with valvular heart diseases than in patients with coronary heart disease and congenital heart diseases (p<0.001). The accumulated probability of not undergoing surgery was higher in patients with valvular heart diseases than in the other patients (p<0.001), and, among the patients with valvular heart diseases, this probability was higher in females than in males (p<0.01). Several patients experienced intense anxiety and attributed their adaptive problems in the scope of love, professional, and social lives, to not undergoing surgery. CONCLUSION - Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions
