353Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):353- ORIGINAL ARTICLE Abstract Introduction: Characteristics of the patient and the coronary artery bypass grafting may predispose individuals to prolonged hospitalization, increasing costs and morbidity and mortality.Objective: The objective of this study was to evaluate individual and perioperative risk factors of prolonged hospitalization in intensive care units and wards.Methods: We conducted a case-control study of 104 patients undergoing isolated coronary artery bypass grafting with cardiopulmonary bypass. Patients hospitalized >3 days in the intensive care unit or >7 days in the ward were considered for the study. The association between variables was estimated by the chi-square test, odds ratio and logistic regression; P ≤0.05 was considered statistically significant.Results: Hospital stay >3 days in the intensive care unit occurred for 22.1% of patients and >7 days in the ward for 27.9%. Among preoperative factors, diabetes (OR=3.17) and smoking (OR=4.07) were predictors of prolonged intensive care unit stay. Combining the pre-, intra-and postoperative variables, only mechanical ventilation for more than 24 hours (OR=6.10) was predictive of intensive care unit outcome. For the ward outcome, the preoperative predictor was left ventricular ejection fraction <50% (OR=3.04). Combining pre-and intraoperative factors, diabetes (OR=2.81), and including postoperative factors, presence of infection (OR=4.54) were predictors of prolonged hospitalization in the ward.Conclusion: Diabetes and smoking were predictors of intensive care unit outcome, and ejection fraction <50% of ward outcome. For the set of perioperative factors, prolonged hospitalization after isolated coronary artery bypass grafting was associated with mechanical ventilation >24 hours for the intensive care unit and presence of infection for the ward.Descriptors: Risk factors. Myocardial revascularization. Hospitalization. ResumoIntrodução: Características do paciente e da cirurgia de revascularização do miocárdio podem predispor à internação prolongada, aumentando custos e a morbimortalidade.Objetivo: Avaliar fatores de risco individuais e transoperató-rios para internação prolongada na unidade de terapia intensiva e na enfermaria. 354Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(3):353-63 Oliveira EK, et al. -Risk factors for prolonged hospital stay after isolated coronary artery bypass grafting productivity [4,8], affecting family budgets, quality of life and increasing costs [1]. Bashour et al. [7] showed that, after cardiac surgery, many patients with prolonged hospital stay died soon after discharge and that the functional status of those who survived for a longer period was worse when compared with those who recovered faster. RevIn this context, the objective of this study was to identify pre-, intra-and postoperative risk factors for long hospitalizations in the ICU or the ward, of patients undergoing isolated CABG surgery w...

Relação do teste de caminhada pós-operatório e função pulmonar com o tempo de internação da cirurgia cardíacaRelationship of postoperative walk test and lung function with the length of heart surgery hospital stay Abstract Objective: The lung function is identified as a predictor of time of hospital stay in heart surgery. Meanwhile six-minute walk test has been used to establish functional capacity of cardiac patients, however there are few studies that correlate it with the length of hospital stay. The aim of this study was to determine whether there is correlation of preoperative and postoperative lung function and the postoperative deambulation ability with postoperative hospital stay.Methods: A prospective cohort with 18 patients was performed, being 8 males and 10 females, with age above 40 years (mean 64.89 ± 6.95 years). Patients where admitted for coronary artery bypass graft surgery and/or valve replacement. To characterize the pulmonary function, patients had undergone spirometry in preoperative and at 5th postoperative day. In the latter period was also performed a test for 6 minutes walk (6MWT) to characterize the deambulation ability.Results: There was not significant correlation of preoperative and postoperative lung function with length of postoperative hospital stay. Only the distance covered in 6MWT showed a significant negative correlation (rho=-0.62) with length postoperative hospital of stay. The distance in 6MWT obtained a significant positive correlation with forced vital capacity (r=0.59) and first second of a maximal forced expiratory maneuver (r=0.52). Conclusion:These results suggest that patients with increased postoperative deambulation capacity have a shorter time of hospital stay and it also suggests that the distance in the 6MWT can better represent the functional capacity of these patients than lung function alone. Descriptors: Respiratory function tests. Early ambulation. Length of stay. Cardiovascular surgical procedures.Resumo Objetivo: A função pulmonar é apontada como preditora do tempo de hospitalização na cirurgia cardíaca. E o teste de caminhada de seis minutos (TC6') tem sido utilizado para caracterizar a capacidade funcional em pacientes cardiopatas, porém há poucos estudos que o correlacione com tempo de internação hospitalar. O objetivo desta pesquisa foi verificar se há correlação da função pulmonar pré e pós-operatória e da capacidade da deambulação pós-operatória com tempo de internação pós-operatória.Métodos: Foi realizada uma coorte prospectiva com 18 pacientes, sendo 8 do gênero masculino e 10 do gênero feminino, com idade acima de 40 anos (média 64,89 ± 6,95 anos), internados para a submissão de cirurgias de revascularização do miocárdio e/ou troca valvar. Para caracterizar a função pulmonar, os pacientes foram submetidos a uma espirometria no pré-operatório e ao 5°C orrespondence address: Vinicius Zacarias Maldaner da Silva

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Background: Glycemic disorders are strong predictors of mortality in ST-elevation myocardial infarction (STEMI) patients, and disruption in nitric oxide (NO) production is associated with insulin-resistant states. We evaluated whether a defective allele of the neuronal nitric oxide synthase (nNOS) gene (NOS1) might influence insulin response and blood-glucose balance during the acute phase of STEMI and if post-infarction total plasma-NO levels and vasodilation scores varied across nNOS genotypes. Methods: Consecutive patients with STEMI (n=354) underwent clinical evaluations and genotyping for the promoter variation rs41279104. In-hospital clinical and blood evaluations were performed at admission and five days after STEMI, with glycemic, insulinemic, and disposition indices assessed at the same times. Flow-mediated dilation (FMD) was assessed by reactive hyperemia on the 30th day. Results: Homozygotes for the defective allele (A) showed lower glycemia and insulin sensitivity on day 1 while showing the highest β-cell function and no changes in the circulating NO pool, which is compatible with hyperresponsive β cells counteracting the inherent glucoseresistant state of AA patients. At day 5, glycemic scores had shifted to indicate greater insulin sensitivity among A homozygotes, paralleled by a significant yet poor increase in NO bioavailability compared to that among G carriers. All in all, defective homozygotes showed greater insulin resistance at admission that had reversed by 5 days after STEMI. Even so, A carriers developed lower FMD scores compared to G homozygotes after the acute phase. Conclusion:A defective nNOS allele (and due decline in NO production) seemed to elicit a hyperinsulinemia response to compensate for an insulin-resistant state during the acute phase of STEMI and to be associated with poor endothelial function after the acute phase.

Background: glycemia disorders are a strong predictor of mortality in ST-Elevation Myocardial Infarction (STEMI) patients. Disruption in nitric oxide (NO) production is associated with insulin-resistant states. We evaluated whether NO production in carriers of a defective allele of the neuronal nitric oxide synthase (nNOS or NOS1), whose in vivo expression is reduced by up to 50%, might influence the insulin response during acute phase of STEMI. Methods and Results: Consecutive patients with STEMI (n = 354) underwent clinical evaluations and genotyping for the promoter variation rs41279104. Blood tests were performed at admission (D1) and after five days (D5) of in-hospital follow up, with the disposition index assessed in the period. Flow-mediated dilation (FMD) was assessed by reactive hyperemia on the 30th day. Homozygotes for the defective allele (A) showed lower glycemia and insulin sensitivity at D1 while showing the highest b-cells function and no changes in the circulating NO pool, what is compatible with hyperresponsive b-cells to counteract the inherent glucose-resistant state of AA patients. At D5, glycemic scores shifted to indicate greater insulin sensitivity among A homozygotes, paralleled by a slight yet poor increase in NO bioavailability than that among G carriers. All in all, defective homozygotes showed greater insulin resistance expressed by the disposition index at admission, which was compensated 5 days after STEMI even though FMD of A carriers was lower compared to G homozygotes. Conclusion: a defective nNOS allele seems to elicit endocrine adaptation and to associate with insulin resistance during the acute phase of STEMI.