Preditores de disfunção neurológica maior após cirurgia de revascularização miocárdica isolada

Guaragna, João Carlos Vieira da Costa; Bolsi, D; Jaeger, Cristiano Pederneiras; Melchior, Raquel; Petracco, João Batista; Facchi, Luciane Maria; Albuquerque, Luciano Cabral

doi:10.1590/s0102-76382006000200010

Cited by 9 publications

(16 citation statements)

References 22 publications

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“…While, Antunes et al postulated that aortic clamping itself is single or intermittent, and it is also a risk factor for the occurrence of stroke, increasing the risk by 1.3 times for each additional period of aortic clamping [27]. Guaragna et al [28] claim that these events are caused not only by the clamping time, but by the presence and location of plaques in the aorta that can lead to the formation of microbubbles that result from the manipulation of the aorta at the time of the application and removal of aortic clamps as shown by Barbut et al [29]. In this study, the only postoperative variable which showed anassociation with the encephalopathy was prolonged mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery

Nina¹,

Rocha²,

Rodrigues³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Introduction: Neurological dysfunction is a feared postoperative morbidity of cardiac surgery, an important cause of death and increased spending in hospitals. Its prediction, however, is still uncertain.Objective: To assess the applicability of a preoperative score as a predictor of neurological dysfunction after coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB).Methods: Prospective study that evaluated 77 patients who underwent CABG from February to October 2011. Using the score CABDEAL (creatinine, age, body mass index, diabetes, emergency surgery, abnormality on ECG, lung disease), patients were grouped into high (CABDEAL > 4) and low risk (CABDEAL<4). The predictive value of the score was compared with intraoperative and postoperative variables (aortic clamping time, CPB and ventilation time) as predictors of encephalopathy and stroke. Data were analyzed with descriptive statistics and compared with the Fisher exact test. ROC curve analysis was performed to evaluate the accuracy of the model for the neurological outcomes. It was considered the significant value P<0.05.Results: The mortality rate was 2.6% (n=2). There were 2 episodes of stroke (2.6%) and 12 (15.5%) of encephalopathy. High risk CABDEAL (P=0.0009), ventilation time (P=0.014), CPB time (P=0.02) and aortic clamping time (P=0.006) were significantly associated with encephalopathy. The aortic clamping time was also associated with stroke (P=0.03) and Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery Bras Cir Cardiovasc 2012;27(3):429-35 death (P=0.006). CABDEAL score showed the largest area under the ROC curve rather than others variables.CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery RevConclusion: In this study, the CABDEAL score stood out as the best predictor of encephalopathy after CABG when compared to the others intraoperative variables.Keywords: Myocardial revascularization. Risk assessment. Morbidity. Brain damage. Resumo Introdução: As complicações neurológicas são temidas no pós-operatório das cirurgias cardíacas, sendo importante causa de óbito e de gastos hospitalares. Sua predição ainda é incerta.Objetivo: Avaliar a aplicabilidade de um escore pré-operatório como preditor de disfunção neurológica no pós-operatório de revascularização miocárdica (RM) com circulação extracorpórea (CEC). Métodos

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Section: Discussionmentioning

confidence: 99%

Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery

Nina¹,

Rocha²,

Rodrigues³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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“…The risk of patients who are undergoing valve replacement differs from those patients undergoing CABG. The work of Guaragna et al [31] brings a score developed especially in patients undergoing valve replacement. The presence of high creatinine level was an important risk predictor for death in this study.…”

Section: Discussionmentioning

confidence: 99%

Proposição de um escore de risco cirúrgico em pacientes submetidos à cirurgia de revascularização miocárdica

Cadore¹,

Guaragna²,

Anacker³

et al. 2010

Rev Bras Cir Cardiovasc

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“…These patients prothrombotic condition, due to increased blood viscosity and endothelial dysfunction. Moreover, often share comorbidities like atherosclerosis, smoking and systemic vascular disease, and are more prone to complications in the postoperative period [35][36][37]. However, some studies do not point to COPD as a predictor of prolonged MV [24,[28][29][30]32].…”

Section: Descriptive Level Of Probability Of the Fisher Exact Test Amentioning

confidence: 99%

Independent predictors of prolonged mechanical ventilation after coronary artery bypass surgery

Piotto¹,

Ferreira²,

Colósimo³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Objective: To determine independent predictors of prolonged mechanical ventilation in patients undergoing coronary artery bypass graft surgery.Methods: Data of patients undergoing coronary artery bypass graft surgery were included prospectively from July 2009 to July 2010. All data were input into an electronic database. The resulting cohort included a total of 2952 patients of which 77 remained more than 48 hours on mechanical ventilation. Patients were divided into two groups: 1) a prolonged ventilation group, needing mechanical ventilation for more than 48 hours and 2) not prolonged ventilation group, undergoing a successful extubation within 48 hours.Results: After adjustment for confounding factors a multivariate analysis identified the following factors as independent predictors of prolonged mechanical ventilation: age (OR 1.06 95% CI 1.03 -1.09; P <0.001), chronic renal failure (OR 3.52 95% CI 1.84 -6.74; P <0.001), chronic obstructive pulmonary disease (OR 2.65 95% CI 1.38 -5.09; P = 0.004), coronary artery bypass graft associated with other procedures (OR 3.33 95 % CI 1.89 -5.58; P <0.001) and clamping time (OR 1.01 95% CI 1.00 -1.02; P = 0.018).Conclusion: The identification of these predictors allows the development of preventive strategies that could reduce invasive ventilation time, since patients on prolonged mechanical ventilation present greater morbidity and mortality rates.Descriptors: Myocardial revascularization. Respiration, artificial. Intensive care units. 521Rev Bras Cir Cardiovasc 2012;27(4) :520-8 Piotto RF, et al. -Independent predictors of prolonged mechanical ventilation after coronary artery bypass

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Preditores de disfunção neurológica maior após cirurgia de revascularização miocárdica isolada

Abstract: Preditores de disfunção neurológica maior após cirurgia de revascularização miocárdica isolada

Cited by 9 publications

References 22 publications

Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery

Assesment of CABDEAL score as predictor of neurological dysfunction after on-pump coronary artery bypass grafting surgery

Proposição de um escore de risco cirúrgico em pacientes submetidos à cirurgia de revascularização miocárdica

Independent predictors of prolonged mechanical ventilation after coronary artery bypass surgery

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