Immediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the S?o Paulo State: Cross Cohort Study

dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorMICALAY, Raul Armando
dc.contributor.authorBORGOMONI, Gabrielle Barbosa
dc.contributor.authorMICALAY, Anny Katia Puchalski
dc.contributor.authorCAMACHO, Jose Carlos Arteaga
dc.contributor.authorDALLAN, Luis Roberto Palma
dc.contributor.authorLISBOA, Luiz Augusto Ferreira
dc.contributor.authorDALLAN, Luis Alberto de Oliveira
dc.contributor.authorMEJIA, Omar Asdrubal Vilca
dc.contributor.authorGrp Estudos REPLICCAR
dc.date.accessioned2023-06-21T14:06:51Z
dc.date.available2023-06-21T14:06:51Z
dc.date.issued2023
dc.description.abstractBackground: The short-term results after using arterial grafts still raise questions and doubts for medical society. Objective: To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery.Methods: Cross-sectional cohort study in the Sao Paulo Registry of Cardiovascular Surgery II. Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk.Results: After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048).Conclusion: Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin >= 6.40%, had a greater influence on the infectious outcome than the choice of grafts.eng
dc.description.abstractFundamento: Os resultados a curto prazo após o uso de enxertos arteriais ainda suscitam questionamentos e dúvidas na sociedade médica. Objetivo: Comparar os resultados imediatos de pacientes submetidos à cirurgia de revascularização do miocárdio com enxerto arterial único versus enxertos arteriais múltiplos. Métodos: Estudo de coorte transversal no Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). Os dados perioperatórios de 3122 pacientes foram agrupados pelo número de enxertos arteriais utilizados e seus desfechos foram comparados: reoperação, infecção profunda da ferida torácica (IPFT), acidente vascular cerebral, lesão renal aguda, intubação prolongada (>24 horas), tempo de internação curta (<6 dias), tempo de internação prolongada (>14 dias), morbidade e mortalidade. O Propensity Score Matching (PSM) correspondeu a 1062 pacientes, ajustado para o risco de mortalidade. Resultados: Após PSM, o grupo enxerto arterial único apresentou pacientes com idade avançada, mais ex-fumantes, hipertensos, diabéticos, portadores de angina estável e infarto do miocárdio prévio. Nos enxertos arteriais múltiplos houve predomínio do sexo masculino, pneumonia recente e cirurgias de urgência. Após o procedimento, houve maior incidência de derrame pleural (p=0,042), pneumonia (p=0,01), reintubação (p=0,006), IPFT (p=0,007) e desbridamento esternal (p=0,015) no grupo de enxertos multiarteriais, porém, menor necessidade de hemotransfusão (p=0,005), infecções de extremidades (p=0,002) e menor tempo de internação (p=0,036). O uso bilateral da artéria torácica interna não foi relacionado ao aumento da taxa de IPFT, e sim a hemoglobina glicosilada >6,40% (p=0,048). Conclusão: Pacientes submetidos a técnica multiarterial apresentaram maior incidência de complicações pulmonares e IPFT, sendo que a hemoglobina glicosilada ≥6,40% teve maior influência no resultado infeccioso do que a escolha dos enxertos.
dc.description.indexMEDLINE
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.indexScielo
dc.identifier.citationARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.120, n.3, article ID e20220627, 9p, 2023
dc.identifier.doi10.36660/abc.20220627
dc.identifier.eissn1678-4170
dc.identifier.issn0066-782X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/53843
dc.language.isoeng
dc.language.isopor
dc.publisherARQUIVOS BRASILEIROS CARDIOLOGIAeng
dc.relation.ispartofArquivos Brasileiros de Cardiologia
dc.rightsopenAccesseng
dc.rights.holderCopyright ARQUIVOS BRASILEIROS CARDIOLOGIAeng
dc.subjectDatabaseeng
dc.subjectMyocardial Revascularizationeng
dc.subjectIndicators of Morbidity and Mortalityeng
dc.subjectGlycated Hemoglobin Aeng
dc.subjectBanco de dados
dc.subjectRevascularização Miocárdica
dc.subjectHemoglobina A Glicada
dc.subjectIndicadores de Morbimortalidade
dc.subject.otherrevascularizationeng
dc.subject.otheroutcomeseng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleImmediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the S?o Paulo State: Cross Cohort Studyeng
dc.title.alternativeResultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.author.externalMICALAY, Raul Armando:Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Inst Coracao InCor, Sao Paulo, SP, Brazil; Hosp Sao Vicente Paulo, Mafra, SC, Brazil
hcfmusp.author.externalMICALAY, Anny Katia Puchalski:Hosp Sao Vicente Paulo, Mafra, SC, Brazil
hcfmusp.author.externalCAMACHO, Jose Carlos Arteaga:Hosp Beneficencia Portuguesa Sao Paulo, Sao Paulo, SP, Brazil
hcfmusp.citation.scopus1
hcfmusp.contributor.author-fmusphcGABRIELLE BARBOSA BORGOMONI
hcfmusp.contributor.author-fmusphcLUIS ALBERTO OLIVEIRA DALLAN
hcfmusp.contributor.author-fmusphcLUIZ AUGUSTO FERREIRA LISBOA
hcfmusp.contributor.author-fmusphcOMAR ASDRUBAL VILCA MEJIA
hcfmusp.description.articlenumbere20220627
hcfmusp.description.issue3
hcfmusp.description.volume120
hcfmusp.origemWOS
hcfmusp.origem.pubmed36946859
hcfmusp.origem.scieloSCIELO:S0066-782X2023000300304
hcfmusp.origem.scopus2-s2.0-85150813485
hcfmusp.origem.wosWOS:000957314800001
hcfmusp.publisher.cityRIO DE JANEIROeng
hcfmusp.publisher.countryBRAZILeng
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hcfmusp.scopus.lastupdate2024-06-16
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