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Introducción: El aumento significativo de la esperanza de vida en el grupo de octogenarios en Chile ha generado preocupación sobre la eficacia y la necesidad de cirugías cardíacas mayores en esta población incluso cuando el 85 % de ellos llega a dicha edad en condiciones de salud favorables. Objetivos: Este estudio se propuso evaluar la mortalidad hospitalaria y a mediano plazo, así como identificar complicaciones postoperatorias en pacientes octogenarios sometidos a cirugía cardíaca en Chile. Métodos: Se llevó a cabo un estudio observacional retrospectivo en el Hospital Las Higueras de Talcahuano entre enero de 2014 y diciembre de 2022, con una muestra de 79 pacientes. Resultados: Se encontró que el 86% de los procedimientos utilizaron circulación extracorpórea, y el 84% fueron electivos, principalmente cirugías coronarias (54%). La mortalidad intrahospitalaria fue 9%, con el uso preoperatorio de Balón Contrapulsación Intraaórtico identificado como un factor de mal pronóstico. Complicaciones postoperatorias como la Fibrilación Auricular afectaron al 17%, mientras que solo Neumonía y Falla Renal influyeron significativamente en la mortalidad. La supervivencia a 1, 3 y 5 años fue 81%, 76% y 73%, respectivamente. Conclusión: La cirugía cardíaca en octogenarios en Chile presenta resultados comparables a nivel mundial, destacando la importancia del análisis individual por un equipo multidisciplinario al considerar cirugías mayores en pacientes frágiles. El uso de técnicas mínimamente invasivas podría mejorar la calidad de vida, aunque se requieren estudios adicionales con más pacientes para confirmar esta hipótesis.
Background: Background: The significant increase in life expectancy among octogenarians in Chile has raised concerns about the efficacy and need of major cardiac surger in this population, even as 85% of them reach this age in favorable health conditions. Objectives: This study aimed to evaluate in-hospital and medium-term mortality and identify postoperative complications in octogenarian patients undergoing cardiac surgery in Chile. Methods: An observational retrospective study was conducted at Hospital Las Higueras de Talcahuano between January 2014 and December 2022, involving a sample of 79 patients. Results: 86% of procedures utilized extracorporeal circulation, and 84% were elective, predominantly coronary artery surgeries (54%). In-hospital mortality was 9%. Preoperative Intra-Aortic Balloon Pump use identified as a poor prognostic factor. Postoperative complications such as Atrial Fibrillation affected 17%, while only Pneumonia and Renal Failure significantly influenced mortality. Survival at 1, 3, and 5 years was 81%, 76%, and 73%, respectively. Conclusion: Cardiac surgery in octogenarians in Chile yields comparable outcomes to those worldwide, emphasizing the importance of individual assessment by a multidisciplinary team when considering major surgeries in frail patients. The use of minimally invasive techniques may enhance quality of life, although further studies with larger patient cohorts are needed to confirm this hypothesis.
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Humanos , Masculino , Femenino , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Complicaciones Posoperatorias , Análisis de Supervivencia , Estudios Retrospectivos , Estudios de Seguimiento , Mortalidad HospitalariaRESUMEN
OBJECTIVE: To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. STUDY DESIGN: In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. RESULTS: Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P = .008), but not the multivariable regression model (P = .39). Postoperative hospital length of stay was significantly associated with COI (P < .001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30 days of hospital discharge in univariable (P < .094) and multivariable (P = .49) models. CONCLUSION: COI is associated with postoperative hospital length of stay but not all outcomes in patients after congenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.
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Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas , Humanos , Estudios Retrospectivos , Masculino , Cardiopatías Congénitas/cirugía , Femenino , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Lactante , Preescolar , Niño , Georgia/epidemiología , Determinantes Sociales de la Salud , Complicaciones Posoperatorias/epidemiología , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Adolescente , Readmisión del Paciente/estadística & datos numéricos , Resultado del TratamientoRESUMEN
OBJECTIVE: Recent data from major noncardiac surgery suggest that outcomes in frail patients are better predicted by a hospital's volume of frail patients specifically, rather than overall surgical volume. We sought to evaluate this "frailty volume-frailty outcome relationship" in patients undergoing cardiac surgery. METHODS: We studied 72,818 frail patients undergoing coronary artery bypass grafting or valve replacement surgery from 2010 to 2014 using the Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multilevel logistic regression was used to assess the independent effect of frailty volume by quartile on mortality, surgical complications, failure to rescue, nonhome discharge, 30-day readmissions, length of stay, and hospital costs in frail patients. RESULTS: In comparing the highest volume quartiles with the lowest, both overall cardiac surgical volume and volume for frail patients were significantly associated with shorter length of stay and reduced costs. However, frailty volume was also independently associated with significantly reduced in-hospital mortality (odds ratio, 0.79; 95% confidence interval, 0.67-0.94; P = .006) and failure to rescue (odds ratio, 0.83; 95% confidence interval, 0.70-0.98; P = .03), whereas no such association was seen between overall volume and either mortality (odds ratio, 0.94; 95% confidence interval, 0.74-1.10; P = .43) or failure to rescue (odds ratio, 0.98; 95% confidence interval, 0.83-1.17; P = .85). Neither frailty volume nor overall volume showed any significant relationship with the rate of 30-day readmissions. CONCLUSIONS: In frail patients undergoing cardiac surgery, surgical volume of frail patients was a significant independent of predictor of in-hospital mortality and failure to rescue, whereas overall surgical volume was not. Thus, the "frailty volume-outcome relationship" superseded the traditional "volume-outcome relationship" in frail patients with cardiac disease.
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Procedimientos Quirúrgicos Cardíacos , Anciano Frágil/estadística & datos numéricos , Fragilidad , Cardiopatías , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Fracaso de Rescate en Atención a la Salud/estadística & datos numéricos , Femenino , Fragilidad/diagnóstico , Fragilidad/epidemiología , Cardiopatías/epidemiología , Cardiopatías/cirugía , Costos de Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Pronóstico , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Resumen: Objetivo: Describir las características clínicas, resultados operatorios inmediatos y a 5 años de la cirugía de reparación valvular mitral. Material y métodos: Estudio retrospectivo de la cohorte de pacientes operados de reparación valvular por insuficiencia mitral (IM) en el Hospital Guillermo Grant Benavente desde el 2009 hasta marzo 2020 (N=206). Se comparan los pacientes con IM primaria y secundaria en sus características clínicas, ecocardiográficas, técnicas quirúrgicas empleadas, cirugías asociadas, morbimortalidad operatoria, sobrevida y reintervenciones hasta el 30 de mayo de 2020. Resultados: 124(60,2%) hombres. Edad media 62,6±10,5 años. La IM fue primaria en 134 y secundaria en 72. En comparación con los pacientes portadores de IM primaria, aquellos con IM secundaria tuvieron más enfermedad coronaria (69,4% versus 11,9%; p<0,001) y mayor riesgo operatorio (EuroSCORE logístico 7,7±6,7 versus 5,2±7,3; EuroSCORE II 3,4±4,8 versus 2,4±4,7; p<0,001). El mecanismo más frecuente de IM primaria fue tipo II (65,7%) y en las secundarias fue el tipo III (48,6%) seguido del tipo I (30,6%). Las IM primarias se corrigieron principalmente con procedimientos para disminuir el prolapso (76,1%). En las secundarias la técnica más utilizada fue el implante de un anillo exclusivo (76,4%). Hubo 116 cirugías asociadas y 10 (4,9%) conversiones a reemplazo valvular. Hubo 57 complicaciones operatorias y fallecieron 12 (5,8%) pacientes, 5 (3,7%) con IM primaria y 7(9,7%) con IM secundaria. La sobrevivencia global a 5 años fue 83,5% (90% en las primarias y 78% en las secundarias) y hubo 6 reintervenciones. Conclusiones: La cirugía de reparación valvular, tanto en pacientes con IM primaria como secundaria, tuvo una baja mortalidad operatoria y excelentes resultados a 5 años.
Abstract: Aim: To describe the clinical characteristics, operative and long term results of surgical mitral valve repair. Material and methods: Retrospective study of the cohort of patients undergoing valve repair due to mitral regurgitation (MR) at the Guillermo Grant Benavente Hospital from 2009 to March 2020 (N = 206). Patients with primary and secondary MR were compared on clinical and echocardiographic characteristics, surgical techniques, associated surgeries, operative morbidity and mortality, survival and reinterventions up to May 30, 2020. Results: 124 (60.2%) were men. The average age was 62.6±10.5 years. Type of MR was primary in 134 and secondary in 72. Compared to patients with primary MR, those with secondary MR had more coronary artery disease (69.4% versus 11.9%; p <0.001) and greater operative risk (logistic EuroSCORE 7.7±6, 7 versus 5.2±7.3; EuroSCORE II 3.4±4.8 versus 2,4±4.7; p<0.001). The most frequent mechanism of MR was type II in primary (65.7%) and type III (48.6%) followed by type I (30.6%) in secondary MR. Primary MR was corrected mainly with procedures to decrease prolapse (76.1%). In secondary MR the main technique used was the implantation of an exclusive ring (76.4%). There were 116 associated surgeries and 10(4.9%) conversions to valve replacement. There were 57 operative complications and 12(5.8%) patients died, 5 (3.7%) with primary MR and 7 (9.7%) with secondary MR. Overall survival at 5 years was 83.5% (90% in primary MR and 78% in secondary MR) and there were 3 reoperations. Conclusions: Valve repair surgery in both primary and secondary MR patients was associated to a low operative mortality and excellent results at 5 year post surgery.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/métodos , Insuficiencia de la Válvula Mitral/cirugía , Complicaciones Posoperatorias , Ecocardiografía , Análisis de Supervivencia , Chile , Estudios de Seguimiento , Resultado del Tratamiento , Implantación de Prótesis de Válvulas Cardíacas , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagenRESUMEN
OBJECTIVE: This study seeks to assess the safety of overlap in cardiac surgery. METHODS: Coarsened exact matching was used to assess the impact of overlap on outcomes among cardiac surgical interventions (n = 4463) over 2 years (2014-2016). Overlap was categorized as any, beginning, or end overlap. Study subjects were matched 1:1 on 11 variables, including Charlson comorbidity score, surgical costs, body mass index, length of postoperative hospitalization, and race, among others. Serious unanticipated events were studied, including readmission, unplanned return to the operating room, and mortality. RESULTS: A total of 984 patients had any overlap and were matched to similar patients without overlap (n = 1501). For beginning/end overlap, separate matched groups were created (n = 462, n = 329 patients, respectively). Among matched patients, any overlap did not predict unanticipated return to surgery at 30 or 90 days. Any overlap did not predict increased readmission, reoperation, or emergency department visits at 30 or 90 days. Overlap did not predict higher rates of death over follow-up. Beginning/end overlap had results similar to any overlap. CONCLUSIONS: Nonconcurrent, overlapping surgery is not associated with an increase in adverse outcomes in a large, matched cardiac surgery population.
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Procedimientos Quirúrgicos Cardíacos , Adulto , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Comorbilidad , Femenino , Humanos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. METHODS: Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution's database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. RESULTS: 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. CONCLUSION: Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.
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Algoritmos , Disección Aórtica , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Anciano , Disección Aórtica/cirugía , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Medición de Riesgo , Factores de RiesgoRESUMEN
Abstract Introduction: Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. Methods: Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution's database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. Results: 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. Conclusion: Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Algoritmos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Disección Aórtica/cirugía , Modelos Logísticos , Factores de Riesgo , Curva ROC , Mortalidad Hospitalaria/tendencias , Medición de RiesgoRESUMEN
OBJECTIVES: The objectives of this study were to describe a novel statewide registry for cardiac surgery in Brazil (REPLICCAR), to compare a regional risk model (SPScore) with EuroSCORE II and STS, and to understand where quality improvement and safety initiatives can be implemented. METHODS: A total of 11 sites in the state of São Paulo, Brazil, formed an online registry platform to capture information on risk factors and outcomes after cardiac surgery procedures for all consecutive patients. EuroSCORE II and STS values were calculated for each patient. An SPScore model was designed and compared with EuroSCORE II and STS to predict 30-day outcomes: death, reoperation, readmission, and any morbidity. RESULTS: A total of 5222 patients were enrolled in this study between November 2013 and December 2017. The observed 30-day mortality rate was 7.6%. Most patients were older, overweight, and classified as New York Heart Association (NYHA) functional class III; 14.5% of the patient population had a positive diagnosis of rheumatic heart disease, 10.9% had insulin-dependent diabetes, and 19 individuals had a positive diagnosis of Chagas disease. When evaluating the prediction performance, we found that SPScore outperformed EuroSCORE II and STS in the prediction of mortality (0.90 vs. 0.76 and 0.77), reoperation (0.84 vs. 0.60 and 0.56), readmission (0.84 vs. 0.55 and 0.51), and any morbidity (0.80 vs. 0.65 and 0.64), respectively (p<0.001). CONCLUSIONS: The REPLICCAR registry might stimulate the creation of other cardiac surgery registries in developing countries, ultimately improving the regional quality of care provided to patients.
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Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Modelos Estadísticos , Brasil , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Control de Calidad , Sistema de Registros , Medición de Riesgo , SeguridadRESUMEN
OBJECTIVES: Prolonged critical illness after congenital heart surgery disproportionately harms patients and the healthcare system, yet much remains unknown. We aimed to define prolonged critical illness, delineate between nonmodifiable and potentially preventable predictors of prolonged critical illness and prolonged critical illness mortality, and understand the interhospital variation in prolonged critical illness. DESIGN: Observational analysis. SETTING: Pediatric Cardiac Critical Care Consortium clinical registry. PATIENTS: All patients, stratified into neonates (≤28 d) and nonneonates (29 d to 18 yr), admitted to the pediatric cardiac ICU after congenital heart surgery at Pediatric Cardiac Critical Care Consortium hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 2,419 neonates and 10,687 nonneonates from 22 hospitals. The prolonged critical illness cutoff (90th percentile length of stay) was greater than or equal to 35 and greater than or equal to 10 days for neonates and nonneonates, respectively. Cardiac ICU prolonged critical illness mortality was 24% in neonates and 8% in nonneonates (vs 5% and 0.4%, respectively, in nonprolonged critical illness patients). Multivariable logistic regression identified 10 neonatal and 19 nonneonatal prolonged critical illness predictors within strata and eight predictors of mortality. Only mechanical ventilation days and acute renal failure requiring renal replacement therapy predicted prolonged critical illness and prolonged critical illness mortality in both strata. Approximately 40% of the prolonged critical illness predictors were nonmodifiable (preoperative/patient and operative factors), whereas only one of eight prolonged critical illness mortality predictors was nonmodifiable. The remainders were potentially preventable (postoperative critical care delivery variables and complications). Case-mix-adjusted prolonged critical illness rates were compared across hospitals; six hospitals each had lower- and higher-than-expected prolonged critical illness frequency. CONCLUSIONS: Although many prolonged critical illness predictors are nonmodifiable, we identified several predictors to target for improvement. Furthermore, we observed that complications and prolonged critical care therapy drive prolonged critical illness mortality. Wide variation of prolonged critical illness frequency suggests that identifying practices at hospitals with lower-than-expected prolonged critical illness could lead to broader quality improvement initiatives.
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Procedimientos Quirúrgicos Cardíacos/mortalidad , Enfermedad Crítica/epidemiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Niño , Preescolar , Enfermedad Crítica/terapia , Femenino , Cardiopatías/congénito , Cardiopatías/mortalidad , Cardiopatías/cirugía , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Sistema de Registros , Factores de RiesgoAsunto(s)
Cardiología/métodos , Publicaciones Periódicas como Asunto/normas , Edición/normas , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/prevención & control , Adolescente , Adulto , Anciano , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/terapia , Brasil/epidemiología , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Cardiología/estadística & datos numéricos , Cardiomiopatía Hipertrófica/epidemiología , Cardiomiopatía Hipertrófica/mortalidad , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Niño , Enfermedad Crónica , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/prevención & control , Femenino , Cardiopatías Congénitas/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Portugal/epidemiología , Embarazo , Edición/estadística & datos numéricosRESUMEN
OBJECTIVE: Long-term outcomes after cardiac surgery in solid organ transplant recipients are limited in the contemporary literature. The objective of this study is to evaluate postoperative outcomes in these patients, including variables associated with mortality and readmissions. METHODS: All adults undergoing isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve cardiac surgical procedures from 2011 to 2018 were included in this study. Patients with solid organ transplants undergoing cardiac surgery were studied. Primary outcomes included operative (30-day) and 5-year mortality. RESULTS: A total of 11,190 patients underwent isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve operations at our institution from 2011 to 2018. Of these, 129 patients (1%) had solid organ transplants and underwent isolated coronary artery bypass grafting (n = 84), isolated valve (n = 30), or coronary artery bypass grafting + valve (n = 15). Type of organ transplant included 84 patients (65%) with kidney, 27 patients (21%) with liver, 9 patients (7%) with heart, and 9 patients (7%) with lung transplants. The median Society of Thoracic Surgeons Predicted Risk Of Mortality for the cohort was 2.73 (Q1-Q3: 1.67-6.33). Three patients (2%) had an operative (30-day) mortality. Significant variables associated with 5-year mortality on multivariable Cox regression analysis included chronic obstructive pulmonary disease (hazard ratio, 2.44; 1.01-5.90; P = .048) and congestive heart failure (hazard ratio, 4.45; 1.81-10.9; P = .001). Significant variables associated with 5-year readmissions included chronic obstructive pulmonary disease, dialysis dependence, and concomittant valve surgery with coronary artery bypass grafting. Five-year readmission rate was 88%, and patients with valve operations (± coronary artery bypass grafting) had significantly lower (P = .009) freedom from readmission (6%). CONCLUSIONS: Cardiac surgery can be performed with low operative mortality and good long-term survival in patients with solid organ transplants. Five-year hospital readmissions are common, with significantly more readmissions in patients who had valve procedures.
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Procedimientos Quirúrgicos Cardíacos , Receptores de Trasplantes/estadística & datos numéricos , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIMS AND OBJECTIVES: To identify factors associated with the increased bleeding in patients during the postoperative period after cardiac surgery. BACKGROUND: Bleeding is among the most frequent complications that occur in the postoperative period after cardiac surgery, representing one of the major factors in morbidity and mortality. Understanding the factors associated with the increased bleeding may allow nurses to anticipate and prioritise care, thus reducing the mortality associated with this complication. DESIGN: Prospective cohort study. METHODS: Adult patients in a cardiac hospital who were in the postoperative period following cardiac surgery were included. Factors associated with the increased bleeding were investigated by means of linear regression, considering time intervals of 6 and 12 hr. RESULTS: The sample comprised 391 participants. The factors associated with the increased bleeding in the first 6 hr were male sex, body mass index, cardiopulmonary bypass duration, anoxia duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative period. Predictors in the first 12 hr were body mass index, cardiopulmonary bypass duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative. CONCLUSIONS: This study identified factors associated with the increased postoperative bleeding from cardiac surgery that have not been reported in previous studies. The nurse is important in the vigilance, evaluation and registry of chest tube drainage and modifiable factors associated with the increased bleeding, such as metabolic acidosis and postoperative heart rate, and in discussions with the multiprofessional team. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the factors associated with the increased bleeding is critical for nurses so they can provide prophylactic interventions and early postoperative treatment when needed.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/enfermería , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/enfermería , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Drenaje/enfermería , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial/efectos adversos , Hemorragia Posoperatoria/prevención & control , Periodo Posoperatorio , Estudios Prospectivos , Factores SexualesRESUMEN
OBJECTIVE: To establish the impact that timing of diagnosis and place of birth have on neonatal outcomes in those with readily treatable critical congenital heart disease. STUDY DESIGN: This was a population-based study with a complete national cohort of live-born infants with transposition of the great arteries and aortic arch obstruction in New Zealand between 2006 and 2014. Timing of diagnosis, place of birth, survival to surgery, in-hospital events, and neonatal mortality were reviewed. Live births with a gestation of ≥35 weeks and without associated major extracardiac anomalies were included for analysis. RESULTS: A total of 166 live-born infants with transposition of the great arteries and 87 with aortic arch obstruction were included. Antenatal detection increased from 32% in the first 3 years to 47% in the last 3 years (P = .05). During the same period, neonatal mortality decreased from 9% to 1% (P = .02). No deaths occurred after surgical intervention. An antenatal diagnosis was associated with decreased mortality (1/97 [1%] vs 11/156 [7%]; P = .03) and birth outside the surgical center was associated with increased risk of mortality (11/147 [7%] vs 1/106 [1%]; P = .02). Those with an antenatal diagnosis required fewer hours of mechanical ventilation (P = .02) and had shorter durations of hospital stay (P = .05) compared with those diagnosed >48 hours after birth. CONCLUSIONS: The mortality risk for transposition of the great arteries and critical aortic arch obstruction is greatest before cardiac surgery. Improved antenatal detection allowing delivery at a surgical center is associated with reduced mortality.
Asunto(s)
Síndromes del Arco Aórtico/mortalidad , Mortalidad Infantil/tendencias , Diagnóstico Prenatal/estadística & datos numéricos , Transposición de los Grandes Vasos/mortalidad , Síndromes del Arco Aórtico/complicaciones , Síndromes del Arco Aórtico/diagnóstico , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Nueva Zelanda , Embarazo , Factores de Tiempo , Transposición de los Grandes Vasos/complicaciones , Transposición de los Grandes Vasos/diagnósticoRESUMEN
Introdução: o número de crianças que nascem com algum tipo de cardiopatia congênita é elevado e a correção cirúrgica é o principal tratamento nesses casos. A fisioterapia atua com técnicas que auxiliam na recuperação e atenuam disfunções decorrentes do internamento. Objetivo: descrever o perfil clínico de crianças no pós-operatório de cirurgia cardíaca e as principais técnicas fisioterapêuticas utilizadas na Unidade de Terapia Intensiva de um hospital de referência pediátrico do município de Salvador. Metodologia: estudo transversal, com 49 pacientes em hospital de referência em pediatria, submetidos à cirurgia cardíaca no período de novembro de 2016 a agosto de 2017, em hospital de referência em Pediatria. Foram coletados dados dos prontuários referentes a gênero, idade, presença de outras malformações associadas, tipo de cardiopatia, tempo de ventilação mecânica, tempo de internamento na unidade de tratamento intensivo e óbito durante a estada nessa unidade. Resultados: do total da amostra, 53% eram do sexo feminino. A média de idade foi de 13 meses. Quanto ao tipo de cardiopatia, 85,7% foram acianóticas, em relação às doenças associadas, 24,4% eram portadores da Síndrome de Down. Dentre as técnicas fisioterapêuticas mais utilizadas estavam a terapia de higiene brônquica e a cinesioterapia passiva. Conclusão: este estudo demonstrou o perfil clínico dos pacientes no pósoperatório de cirurgias cardíacas, evidenciando uma média de idade de aproximadamente um ano, com discreto predomínio do sexo feminino. As técnicas fisioterapêuticas mais utilizadas foram a terapia de higiene brônquica e a cinesioterapia.
Introduction: the number of children who are born with some kind of congenital heart disease is high and the surgical correction is the main treatment in such cases. Physiotherapy works with techniques that help in the recovery and reduce malfunctions arising from the hospitalization. Objective: describe the clinical profile of children in the postoperative period of cardiac surgery and physiotherapy techniques used in the Intensive Care Unit (ICU) of a reference pediatric hospital of the municipality of. Methodology: cross-sectional study, with 49 patients in pediatric reference hospital who underwent heart surgery in the period from November 2016 to August 2017, in pediatric reference hospital. Data were collected from medical records relating to gender, age, presence of other associated malformations, cardiopathy type, time of VM, time of hospitalization in the ICU and death during a stay in the ICU. Results: of the total sample, 53% were of female sex. The average age was 13 months. As for the type of cardiopathy, 85.7% were acyanotic, in relation to associated diseases, 24.4% were carriers of Down Syndrome. Among the physiotherapeutic techniques used were bronchial hygiene therapy (BHT) and passive kinesitherapy. Conclusion: this study demonstrated the clinical profile of patients in the postoperative period of cardiac surgery, showing an average age of about a year, with discreet predominance of the female sex. The most used physiotherapeutic techniques were the BHT and kinesitherapy.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Cardiopatías Congénitas/cirugía , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Estudios TransversalesRESUMEN
OBJECTIVE: To analyse hospital mortality in patients subjected to cardiac surgery in Mexico during the year 2015, and identify the mortality risks factors, and its correlation with days of hospital stay in the cardiovascular intensive care unit. METHOD: The database of Cardiovascular Intensive Care of the National Institute of Cardiology was examined for this cases and controls study that included only adult patients subjected to cardiac surgery during the year 2015. RESULTS: A total of 571 patients were subjected to a surgical procedure. The predominant indication was single or multiple valve replacement surgery, followed by coronary revascularisation surgery, and correction of adult congenital heart disease. Overall mortality was 9.2, and 8% died in intensive care. The main risk factors for death were preoperative organ failure or pulmonary hypertension, and prolonged time with extracorporeal circulation. The primary cause of death was secondary to cardiogenic shock. The hospital mortality observed in this population was higher for patients undergoing pulmonary thromboendarterectomy, complex aortic disease surgery, and valvular surgery. CONCLUSIONS: The mortality of patients undergoing cardiac surgery in Mexico differs slightly from that reported in the world literature, primarily because there were more multivalvular surgeries and mixed complex procedures performed.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Mortalidad Hospitalaria , Tiempo de Internación/estadística & datos numéricos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Bases de Datos Factuales , Endarterectomía/métodos , Endarterectomía/mortalidad , Femenino , Cardiopatías Congénitas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Choque Cardiogénico/epidemiología , Choque Cardiogénico/mortalidadRESUMEN
OBJECTIVE: To evaluate and describe resource use and perioperative morbidities among those patients with genetic conditions undergoing cardiac surgery. STUDY DESIGN: Using the Pediatric Health Information System database, we identified patients ≤18 years old with cardiac surgery classified by Risk Adjustment for Congenital Heart Surgery (RACHS) during 2003-2014. A total of 95 253 patients met study criteria and included no genetic conditions (84.6%), trisomy 21 (9.9%), trisomy 13 or 18 (0.2%), 22q11 deletion (0.8%), Turner syndrome (0.4%), and "other" genetic conditions (4.2%). We compared perioperative complications and procedures in each genetic condition with patients without genetic conditions using regression analysis. RESULTS: All groups with genetic conditions, excluding trisomy 21 RACHS 3-5, experienced increased length of stay and cost among survivors. Complications varied by genetic condition, with patients with trisomy 21 having increased odds of pulmonary hypertension and nosocomial infections. Patients with 22q11 only had increased odds of infection. Patients with Turner syndrome had increased odds of acute renal failure (OR 2.35). Patients with trisomy 13 or 18 had increased odds of pulmonary hypertension (OR 3.13), acute renal failure (OR 2.93), cardiac arrest (OR 2.84), and nosocomial infections (OR 3.53), and those with "other" genetic conditions had increased odds of all complications. CONCLUSIONS: Children with congenital heart disease and genetic conditions, except trisomy 21 RACHS 3-5, had increased costs and length of stay. Perioperative morbidities were more common and differed across genetic condition subgroups. Patient-specific risk factors are important for risk stratification, benchmarking, and counseling with families.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Enfermedades Genéticas Congénitas/cirugía , Cardiopatías Congénitas/cirugía , Aceptación de la Atención de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/economía , Niño , Preescolar , Estudios Transversales , Bases de Datos Factuales , Femenino , Enfermedades Genéticas Congénitas/complicaciones , Costos de la Atención en Salud/estadística & datos numéricos , Cardiopatías Congénitas/genética , Humanos , Lactante , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Morbilidad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Estados UnidosRESUMEN
Resumen Objetivo: Analizar las causas de mortalidad hospitalaria de pacientes operados de cirugía cardiaca en México en el año 2015. Identificar los factores de riesgo de mortalidad y realizar una correlación con el tiempo de estancia hospitalaria en terapia intensiva cardiovascular. Método: Estudio de casos y controles. Se estudió la base de datos de la Terapia Intensiva Cardiovascular del Instituto Nacional de Cardiología. Se incluyeron todos los pacientes adultos operados de cirugía cardiaca en el año 2015. Resultados: Se operaron 571 pacientes. La indicación quirúrgica predominante fue la cirugía de cambio valvular único o múltiple, seguida de la cirugía de revascularización coronaria y corrección de cardiopatías congénitas del adulto. La mortalidad global fue de un 9.2% y el 8% falleció en terapia intensiva. Los principales factores de riesgo de muerte fueron la presencia de falla orgánica o hipertensión pulmonar prequirúrgica, y el tiempo prolongado de circulación extracorpórea. La principal causa de muerte fue el choque cardiogénico. La mortalidad hospitalaria observada en esta población fue mayor para los operados de tromboendarterectomía pulmonar, cirugía de enfermedad aórtica compleja y cirugía valvular. Conclusiones: La mortalidad de los pacientes operados de cirugía cardiaca en México difiere levemente de la reportada en la literatura mundial porque se trata mayormente de cirugía multivalvular y de procedimientos quirúrgicos mixtos complejos.
Abstract Objective: To analyse hospital mortality in patients subjected to cardiac surgery in Mexico during the year 2015, and identify the mortality risks factors, and its correlation with days of hospital stay in the cardiovascular intensive care unit. Method: The database of Cardiovascular Intensive Care of the National Institute of Cardiology was examined for this cases and controls study that included only adult patients subjected to cardiac surgery during the year 2015. Results: A total of 571 patients were subjected to a surgical procedure. The predominant indication was single or multiple valve replacement surgery, followed by coronary revascularisation surgery, and correction of adult congenital heart disease. Overall mortality was 9.2, and 8% died in intensive care. The main risk factors for death were preoperative organ failure or pulmo- nary hypertension, and prolonged time with extracorporeal circulation. The primary cause of death was secondary to cardiogenic shock. The hospital mortality observed in this population was higher for patients undergoing pulmonary thromboendarterectomy, complex aortic disease surgery, and valvular surgery. Conclusions: The mortality of patients undergoing cardiac surgery in Mexico differs slightly from that reported in the world literature, primarily because there were more multivalvular surgeries and mixed complex procedures performed.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Mortalidad Hospitalaria , Procedimientos Quirúrgicos Cardíacos/métodos , Tiempo de Internación/estadística & datos numéricos , Choque Cardiogénico/mortalidad , Choque Cardiogénico/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Bases de Datos Factuales , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Endarterectomía/métodos , Endarterectomía/mortalidad , Cardiopatías Congénitas/cirugía , Procedimientos Quirúrgicos Cardíacos/mortalidad , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Unidades de Cuidados Intensivos , México/epidemiologíaAsunto(s)
Altruismo , Procedimientos Quirúrgicos Cardíacos , Misiones Médicas , Actitud del Personal de Salud , Procedimientos Quirúrgicos Cardíacos/educación , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Humanos , Misiones Médicas/organización & administración , Misiones Médicas/estadística & datos numéricosRESUMEN
OBJECTIVE: To test the capacity of the Logistic CASUS Score on the second postoperative day, the total serum bilirubin dosage on the second postoperative day and the extracorporeal circulation time, as possible predictive factors of long-term stay in Intensive Care Unit after cardiac surgery. METHODS: Eight-two patients submitted to cardiac surgery with extracorporeal circulation were selected. The Logistic CASUS Score on the second postoperative day was calculated and bilirubin dosage on the second postoperative day was measured. The extracorporeal circulation time was also registered. Patients were divided into two groups: Group A, those who were discharged up to the second day of postoperative care; Group B, those who were discharged after the second day of postoperative care. RESULTS: In this study, 40 cases were listed in Group A and 42 cases in Group B. The mean extracorporeal circulation time was 83.9±29.4 min in Group A and 95.8±29.31 min in Group B. Extracorporeal circulation time was not significant in this study (P=0.0735). The level of P significance of bilirubin dosage on the second postoperative day was 0.0003 and an area under the ROC curve of 0.708 with a cut-off point at 0.51 mg/dl was registered. The level of P significance of Logistic CASUS Score on the second postoperative day was 0.0001 and an area under the ROC curve of 0.723 with a cut-off point at 0.40% was registered. CONCLUSION: The Logistic CASUS Score on the second postoperative day has shown to be better than the bilirubin dosage on the second postoperative day as a predictive tool for calculating the length of stay in intensive care unit during the postoperative care period of patients. Notwithstanding, extracorporeal circulation time has failed to prove itself as an efficient tool to predict an extended length of stay in intensive care unit.
Asunto(s)
Bilirrubina/sangre , Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Circulación Extracorporea , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Factores de RiesgoRESUMEN
INTRODUCTION: The outcomes of Jehovah's Witness (JW) patients submitted to open heart surgery may vary across countries and communities. The aim of this study was to describe the morbidity and mortality of JW patients undergoing cardiac surgery in a tertiary hospital center in Southern Brazil. METHODS: A case-control study was conducted including all JW patients submitted to cardiac surgery from 2008 to 2016. Three consecutive surgical non-JW controls were matched to each selected JW patient. The preoperative risk of death was estimated through the mean EuroSCORE II. RESULTS: We studied 16 JW patients with a mean age of 60.6±12.1 years. The non-JW group included 48 patients with a mean age of 63.3±11.1 years (P=0.416). Isolated coronary artery bypass graft surgery was the most frequent surgery performed in both groups. Median EuroSCORE II was 1.29 (IQR: 0.66-3.08) and 1.43 (IQR: 0.72-2.63), respectively (P=0.988). The mortality tended to be higher in JW patients (18.8% vs. 4.2%, P=0.095), and there was a higher difference between the predicted and observed mortality in JW patients compared with controls (4.1 and 18.8% vs. 2.1 and 4.2%). More JW patients needed hemodialysis in the postoperative period (20.0 vs. 2.1%, P=0.039). CONCLUSION: We showed a high rate of in-hospital mortality in JW patients submitted to cardiac surgery. The EuroSCORE II may underestimate the surgical risk in these patients.