Influência da hipertensão pulmonar na mortalidade dos pacientes submetidos a cirurgia de revascularização miocárdica
Influência da hipertensão pulmonar na mortalidade dos pacientes submetidos a cirurgia de revascularização miocárdica
Data
2018
Autores
Guina, Octávio Drummond
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Fundamento: A hipertensão pulmonar (HP) é causa de morbimortalidade em diversos
cenários, sobretudo nos pacientes submetidos à cirurgia cardíaca.
Objetivo: Avaliar a mortalidade hospitalar, complicações cirúrgicas e sobrevida dos
pacientes portadores de HP submetidos à cirurgia de revascularização miocárdica
isolada, de caráter eletivo.
Métodos: Estudo de coorte, retrospectivo, em um período de 7 anos, através da
análise de prontuários e banco de dados. Os pacientes foram divididos em dois grupos
a partir da pressão sistólica da artéria pulmonar (PSAP). Fatores associados de forma
independente aos eventos de interesse foram determinados através de regressão
logística e análises uni e multivariada.
Resultados: Foram analisados 1.985 pacientes, divididos em dois grupos. O grupo 1,
com PSAP < 36 mmHg (1.885 pacientes) e o grupo 2 com PSAP ≥ 36 mmHg (100
pacientes). A maioria dos pacientes foi composta pelo sexo masculino (71,5% vs 57%,
p = 0,003), com idade média de 60,7 anos. A mortalidade foi maior no segundo grupo
(16% vs 8,2%, p = 0,015), que também apresentou Euroscore I maior (2,0 vs 4,0, p <
0,001), elevada incidência de disfunção ventricular esquerda (27,4% vs 52%, p <
0,001), insuficiência renal com necessidade de hemodiálise superior (2,0% vs 5,0%, p
= 0,001), assim como os tempos de permanência em dias em unidade pós-operatória
(3,0 vs 3,0, p = 0,009) e hospitalar (12,0 vs 14,0, p = 0,023). Não houve relevância
estatística na comparação entre a sobrevida de ambos os grupos (p = 0,065).
Conclusão: Pacientes com níveis de PSAP ≥ 36 mmHg apresentam taxa de
mortalidade, tempo de internação em UPO e hospitalar maior em relação aqueles com
PSAP < 36 mmHg. A ocorrência de complicações como IAM, AVE, mediastinite,
hemorragia e hemoderivados (concentrado de hemácias, plaquetas, crioprecipitado e
plasma fresco) foi semelhante em ambos os grupos, porém com a ocorrência de IRA
com necessidade hemodiálise superior no grupo 2 (PSAP ≥ 36 mmHg). A curva de
sobrevida em um período de 12 anos foi semelhante entre os grupos.
Palavras-chave: Hipertensão pulmonar; Mortalidade; Revascularização miocárdica;
Cirurgia cardíaca;
Background: Pulmonary hypertension (HP) is a cause of morbidity and mortality in several settings, especially in patients undergoing cardiac surgery. Objective: To evaluate hospital mortality, surgical complications and survival of patients with PH submitted to elective myocardial revascularization surgery alone. Methods: A retrospective cohort study over a 7-year period, through the analysis of medical records and database. Patients were divided into two groups from pulmonary artery systolic pressure (PSAP). Factors independently associated with the events of interest were determined through logistic regression and univariate and multivariate analyzes. Results: A total of 1,985 patients were analyzed, divided into two groups. Group 1, with PSAP <36 mmHg (1,885 patients) and group 2 with PSAP ≥ 36 mmHg (100 patients). The majority of the patients were male (71.5% vs 57%, p = 0.003), with a mean age of 60.7 years. Mortality was higher in the second group (16% vs 8.2%, p = 0.015), which also presented higher Euroscore I (2.0 vs 4.0, p <0.001), high incidence of left ventricular dysfunction (27, 4% vs 52%, p <0.001), renal failure requiring higher hemodialysis (2.0% vs 5.0%, p = 0.001), as well as residence times in postoperative days (3, 0 vs 3.0, p = 0.009) and hospital (12.0 vs 14.0, p = 0.023). There was no statistical relevance in the comparison between the survival of both groups (p = 0.065). Conclusion: Patients with PSAP levels ≥36 mmHg had a mortality rate, length of hospital stay in UPO, and hospital length over those with PSAP <36 mmHg. The occurrence of complications such as AMI, stroke, mediastinitis, hemorrhage and blood products (packed red blood cells, platelets, cryoprecipitate and fresh plasma) was similar in both groups, but with ARF requiring higher hemodialysis in group 2 (PSAP ≥ 36 mmHg). The survival curve over a 12-year period was similar between groups. Keywords: Pulmonary hypertension; Mortality; Myocardial revascularization; Cardiac surger
Background: Pulmonary hypertension (HP) is a cause of morbidity and mortality in several settings, especially in patients undergoing cardiac surgery. Objective: To evaluate hospital mortality, surgical complications and survival of patients with PH submitted to elective myocardial revascularization surgery alone. Methods: A retrospective cohort study over a 7-year period, through the analysis of medical records and database. Patients were divided into two groups from pulmonary artery systolic pressure (PSAP). Factors independently associated with the events of interest were determined through logistic regression and univariate and multivariate analyzes. Results: A total of 1,985 patients were analyzed, divided into two groups. Group 1, with PSAP <36 mmHg (1,885 patients) and group 2 with PSAP ≥ 36 mmHg (100 patients). The majority of the patients were male (71.5% vs 57%, p = 0.003), with a mean age of 60.7 years. Mortality was higher in the second group (16% vs 8.2%, p = 0.015), which also presented higher Euroscore I (2.0 vs 4.0, p <0.001), high incidence of left ventricular dysfunction (27, 4% vs 52%, p <0.001), renal failure requiring higher hemodialysis (2.0% vs 5.0%, p = 0.001), as well as residence times in postoperative days (3, 0 vs 3.0, p = 0.009) and hospital (12.0 vs 14.0, p = 0.023). There was no statistical relevance in the comparison between the survival of both groups (p = 0.065). Conclusion: Patients with PSAP levels ≥36 mmHg had a mortality rate, length of hospital stay in UPO, and hospital length over those with PSAP <36 mmHg. The occurrence of complications such as AMI, stroke, mediastinitis, hemorrhage and blood products (packed red blood cells, platelets, cryoprecipitate and fresh plasma) was similar in both groups, but with ARF requiring higher hemodialysis in group 2 (PSAP ≥ 36 mmHg). The survival curve over a 12-year period was similar between groups. Keywords: Pulmonary hypertension; Mortality; Myocardial revascularization; Cardiac surger
Description
Palavras-chave
Hipertensão pulmonar, Mortalidade, Revascularização miocárdica, Cirurgia cardíaca, Pulmonary hypertension, Mortality, Myocardial revascularization, Cardiac surgery
Citação
Guina OD. Influência da hipertensão pulmonar na mortalidade dos pacientes submetidos a cirurgia de revascularização miocárdica. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2018.