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Resumo Fundamento Análises em grandes registros apontam desfechos desfavoráveis para mulheres submetidas à cirurgia de revascularização do miocárdio (CRM), enquanto estudos randomizados sofrem com a falta de representatividade. Objetivo Comparar os resultados hospitalares ajustados entre homens e mulheres submetidos à CRM. Métodos Entre julho de 2017 e junho de 2019, 3991 pacientes foram submetidos à CRM primária isolada, tanto de forma eletiva como de urgência, em 5 hospitais de estado de São Paulo, Brasil. Para equilibrar as diferenças entre homens e mulheres, as populações foram ajustadas utilizando o Propensity Score Matching. Os desfechos considerados para análise foram os utilizados pelo STS Adult Database. As análises foram conduzidas no software R, considerando significância valores de p < 0,05. Resultados Após o Propensity Score Matching (1:1), cada grupo incluiu 1089 pacientes. Em relação às variáveis intraoperatórias os homens apresentaram maior tempo de CEC (p<0,001), tempo cirúrgico (p<0,001), número de anastomoses distais (p<0,001) e uso de enxertos arteriais. Em relação aos desfechos as mulheres apresentaram maior incidência de infecção de ferida profunda (p=0,006), tempo prolongado na Unidade de Terapia Intensiva (p=0,002), maior necessidade do uso de balão intraórtico (p=0,04), maior taxa de transfusão sanguínea (p<0,001), maior readmissão hospitalar em até 30 dias após a cirurgia (p=0,002) e maior taxa de óbitos (p=0,03). Conclusões Apesar dos homens terem apresentado um maior tempo de CEC, maior número de enxertos arteriais e maior número de anastomoses distais, os resultados imediatos após CRM foram piores em mulheres.

Abstract Background Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. Objective To compare adjusted hospital outcomes between men and women undergoing CABG. Methods From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. Results After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). Conclusions Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

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INTRODUCTION: A year ago, in a sample of 113 patients, our research group found that a high number of lymphocytes in the immediate postoperative period was correlated to a poor prognosis in cardiovascular surgeries. This study is an expansion of the initial study in order to confirm this finding. METHODS: We analyzed the data of 338 consecutive patients submitted to cardiovascular surgeries with cardiopulmonary bypass performed at Hospital Universitário Ciências Médicas (Belo Horizonte/Brazil) from 2015 to 2017. We analyzed 39 variables with the outcomes death, hospital stay, and intensive care unit stay. RESULTS: The value of lymphocytes in the immediate postoperative period > 2175.0/mm³ was an indicator of poor prognosis in this sample (P<0.001). The variables female sex, age, high level of European System for Cardiac Operative Risk Evaluation II, increased stay in the intensive care unit and in the ward, elevation of creatinine in the preoperative period and at intensive care unit discharge, elevation of the percentage of immediate postoperative period segmented neutrophils, high immediate postoperative period neutrophil/lymphocyte ratio, fasting hyperglycemia, preoperative critical condition, reintubation, mild or transient acute renal failure, surgical infection, cardiopulmonary bypass, and aortic cross-clamping and mechanical ventilation durations also had an impact on the mortality outcome. CONCLUSION: The value of lymphocytes in the immediate postoperative period > 2175.0/mm3 was an indicator of poor prognosis in cardiovascular surgery with cardiopulmonary bypass.

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Introduction: Cardiovascular surgery risk prediction models are widely applied in medical practice. However, they have been criticized for their low methodological quality and scarce external validation. An additional limitation added in Latin America is that most of these models have been developed in the United States or Europe, which present marked geographical differences. The objective of this study is to characterize the postoperative clinical events of cardiovascular surgeries with the use of cardiopulmonary bypass pump in a local setting and to evaluate the prediction of postoperative mortality using the EuroSCORE II predictive model. Methods: Cross-sectional study in an urban university hospital in Buenos Aires. Patients ≥21 years of age were included, with a clinical indication for on-pump cardiovascular surgery. Patients with incomplete clinical data regarding EuroSCORE II variables or in-hospital survival, ≥95 years of age, or undergoing heart transplantation were excluded. Results: 195 patients were enrolled. Postoperative mortality estimated by EuroSCORE II presented a clear underestimation of risk (3.0% vs 7.7%). Discrimination (AUC = 0.82; 95% CI 0.74-0.92) and goodness of fit of the model were adequate (χ2 = 7.91; p = 0.4418). The most frequent postoperative complications were postoperative heart failure (35.9%), vasoplegic shock (13.3%), and cardiogenic shock (10.26%). Conclusion: The EuroSCORE II is an appropriate tool to discriminate between different risk categories in patients undergoing on-pump cardiovascular surgery, although it underestimates the risk.

Introducción: Los modelos de predicción de riesgo de cirugías cardiovasculares se aplican ampliamente a la práctica médica. Sin embargo, han sido criticados por su baja calidad metodológica y escasa validación externa. En América Latina se agrega la limitación de que la mayoría de estos modelos fueron desarrollados en Estados Unidos o Europa, existiendo diferencias geográficas marcadas. Objetivo: El objetivo de este estudio es caracterizar los eventos clínicos postoperatorios de cirugías cardiovasculares con uso de bomba de circulación extracorpórea en un escenario local y evaluar la predicción de mortalidad postoperatoria del modelo predictivo EuroSCORE II. Métodos: Corte transversal en un hospital universitario urbano de Buenos Aires. Se incluyeron a pacientes ≥21 años de edad, con indicación de cirugía cardiovascular con uso de bomba. Se excluyeron a pacientes con datos clínicos incompletos respecto a las variables del EuroSCORE II o respecto a la sobrevida intrahospitalaria, con ≥95 años de edad o sometidos a trasplante cardíaco. Resultados: Se enrolaron 195 pacientes. La mortalidad postoperatoria estimada por el EuroSCORE II presentó una clara subestimación del riesgo (3,0% vs 7,7%). La discriminación (AUC = 0,82; IC95% 0,74-0,92) y la bondad del ajuste del modelo fueron adecuadas (χ2 = 7,91; p = 0,4418). Las complicaciones postoperatorias más frecuentes fueron insuficiencia cardíaca postoperatoria (35,9%), shock vasopléjico (13,3%) y shock cardiogénico (10,26%). Conclusión: El EuroSCORE II es una herramienta apropiada para discriminar entre diferentes categorías de riesgo en pacientes sometidos a cirugías cardiovasculares con uso de bomba, si bien subestima el riesgo.

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ABSTRACT Introduction: A year ago, in a sample of 113 patients, our research group found that a high number of lymphocytes in the immediate postoperative period was correlated to a poor prognosis in cardiovascular surgeries. This study is an expansion of the initial study in order to confirm this finding. Methods: We analyzed the data of 338 consecutive patients submitted to cardiovascular surgeries with cardiopulmonary bypass performed at Hospital Universitário Ciências Médicas (Belo Horizonte/Brazil) from 2015 to 2017. We analyzed 39 variables with the outcomes death, hospital stay, and intensive care unit stay. Results: The value of lymphocytes in the immediate postoperative period > 2175.0/mm³ was an indicator of poor prognosis in this sample (P<0.001). The variables female sex, age, high level of European System for Cardiac Operative Risk Evaluation II, increased stay in the intensive care unit and in the ward, elevation of creatinine in the preoperative period and at intensive care unit discharge, elevation of the percentage of immediate postoperative period segmented neutrophils, high immediate postoperative period neutrophil/lymphocyte ratio, fasting hyperglycemia, preoperative critical condition, reintubation, mild or transient acute renal failure, surgical infection, cardiopulmonary bypass, and aortic cross-clamping and mechanical ventilation durations also had an impact on the mortality outcome. Conclusion: The value of lymphocytes in the immediate postoperative period > 2175.0/mm3 was an indicator of poor prognosis in cardiovascular surgery with cardiopulmonary bypass.

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ABSTRACT BACKGROUND AND OBJECTIVES: Delirium is an acute mental status change, with fluctuating course and high incidence in cardiac surgery (CS) post-operative (PO) period. Delirium can lead to short and long-term consequences. The aim of this study was to assess the prevalence of delirium and pain and their risk factors on the 1st PO day after CS. METHODS: This was a cross-sectional analytical research. To determine the presence of PO delirium, the Confusion Assessment Method modified for Intensive Care Unit setting (CAM-ICU) and the Richmond Agitation Sedation Scale (RASS) were used. PO pain was analyzed using the Visual Analogue Pain Scale (VAS) and the presence of neuropathic components was analyzed using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. After bedside analysis, patients were divided into Delirium (D) and Without Delirium (WD) groups. RESULTS: The total number of patients was 79. The prevalence of delirium was 16.5% (95% CI = 9.06 - 26.49%) and the mean number of comorbidities in the preoperative period was a significant risk factor for the occurrence of delirium (D =4.15±2.37 versus WD=2.96±1.78, p: 0.04). Another significant risk factor was the group older than 65 years of age, with the occurrence of delirium 1.45 times higher (PR=1.12-1.88, p: 0.0014). Regarding pain evaluation, 72.15% (95% CI 60.93 - 81.65%) reported it in the 1st PO day. CONCLUSION: The prevalence of delirium was similar to previous studies. The number of previous comorbidities and advanced age were risk factors for delirium. Pain was present predominantly over the sternotomy incision region.

RESUMO JUSTIFICATIVA E OBJETIVOS: Delirium é uma alteração aguda do estado mental, com curso flutuante e alta incidência no pós-operatório (PO) de cirurgia cardíaca (CC). O delirium pode levar a consequências a curto e longo prazo. O objetivo deste estudo foi avaliar a prevalência de delirium e dor e seus fatores de risco no 1º dia PO após CC. MÉTODOS: Trata-se de um estudo transversal analítico. Para determinar delirium no PO, foram utilizados o Confusion Assessment Method modificado para ambiente de Unidade de Terapia Intensiva (CAM-UTI) e a Richmond Agitation Sedation Scale (RASS). A dor PO foi analisada por meio da Escala Analógica Visual (EAV) e a presença de componentes neuropáticos foi analisada por meio da Escala de Avaliação de Sintomas e Sinais Neuropáticos de Leeds (LANSS). Após análise, os pacientes foram divididos nos grupos Delirium (D) e Sem Delirium (SD). RESULTADOS: Foram estudados 79 pacientes. A prevalência de delirium foi de 16,5% (IC 95%=9,06-26,49%) e o número médio de comorbidades no pré-operatório foi um fator de risco significativo para a ocorrência de delirium (D=4,15±2,37 versus SD=2,96±1,78, p: 0,04). Outro fator de risco foi o grupo com mais de 65 anos, com ocorrência de delirium 1,45 vezes maior (RP=1,12-1,88, p: 0,0014). Em relação à avaliação da dor, 72,15% (IC 95% 60,93-81,65%) a relataram no 1º dia PO. CONCLUSÃO: A prevalência de delirium foi semelhante à de estudos anteriores. O número de comorbidades prévias e a idade avançada foram fatores de risco para delirium. A dor estava presente predominantemente na região da incisão da esternotomia.

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Background An aspect not so clear in the scenario of aortic surgery is how patients fare after composite aortic valve graft replacement (CAVGR) depending on the type of valve (bioprosthetic versus mechanical). We performed a study to evaluate the long-term outcomes of both strategies comparatively. Methods and Results Pooled meta-analysis of Kaplan-Meier-derived time-to-event data from studies with follow-up for overall survival (all-cause death), event-free survival (composite end point of cardiac death, valve-related complications, stroke, bleeding, embolic events, and/or endocarditis), and freedom from reintervention. Twenty-three studies met our eligibility criteria, including 11 428 patients (3786 patients with mechanical valves and 7642 patients with bioprosthetic valve). The overall population was mostly composed of men (mean age, 45.5-75.6 years). In comparison with patients who underwent CAVGR with bioprosthetic valves, patients undergoing CAVGR with mechanical valves presented no statistically significant difference in the risk of all-cause death in the first 30 days after the procedure (hazard ratio [HR], 1.24 [95% CI, 0.95-1.60]; P=0.109), but they had a significantly lower risk of all-cause mortality after the 30-day time point (HR, 0.89 [95% CI, 0.81-0.99]; P=0.039) and lower risk of reintervention (HR, 0.33 [95% CI, 0.24-0.45]; P<0.001). Despite its increased risk for the composite end point in the first 6 years of follow-up (HR, 1.41 [95% CI, 1.09-1.82]; P=0.009), CAVGR with mechanical valves is associated with a lower risk for the composite end point after the 6-year time point (HR, 0.46 [95% CI, 0.31-0.67]; P<0.001). Conclusions CAVGR with mechanical valves is associated with better long-term outcomes in comparison with CAVGR with bioprosthetic valves.

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Resumo Fundamento A endocardite infecciosa (EI) refere-se à infecção da superfície endocárdica do coração e geralmente ocorre em valvas nativas ou protéticas. Objetivo Este estudo teve como objetivo levantar dados de EI refletindo a terapêutica cirúrgica, em um Hospital Universitário do interior do estado de São Paulo - Brasil. Método Abordagem retrospectiva e observacional de 328 pacientes com EI operados entre 1982 e 2020 Resultados Os principais dados (n=121/37%), insuficiência cardíaca congestiva (n=114/35%), valvopatia (n=92/28%), diabetes mellitus (n=85/26%), doença renal crônica (n=59/18%) e febre reumática (49/15%). A insuficiência renal é um dos principais e mais relevantes fatores de risco pré-cirúrgicos para um mau prognóstico. Conclusão Para um melhor resultado clínico e cirúrgico é necessário o diagnóstico sindrômico e etiológico precoce da EI, principalmente em pacientes com múltiplas comorbidades.

Abstract Background Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. Objective This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. Method Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020 Results The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. Conclusion For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

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Abstract Background The COVID-19 pandemic has disrupted the routine of emergency centers around the world, including in Brazil, where the crisis has affected the volume of major cardiac surgeries such as coronary artery bypass grafting. Objective To analyze the impact of the COVID-19 pandemic on the number of surgical procedures for coronary artery bypass grafting in Brazil. Methods An ecological, cross-sectional, quantitative, and descriptive study was conducted. Data for the period from July 2018 to June 2019 and from July 2020 to June 2021 were collected from SIHSUS using DATASUS/Tabwin. Results A global reduction of 26.58% was observed in the analyzed population, with on-pump coronary artery bypass grafting decreasing by 28.10%, and off-pump coronary artery bypass grafting reduced by only 10.31%. Conclusion During the pandemic, there was a 26.58% reduction in the number of surgical procedures for myocardial revascularization in Brazil.

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Introducción: Durante el preoperatorio cardiovascular, las personas presentan con frecuencia niveles altos de depresión, los que se asocian a resultados quirúrgicos poco favorables y, por ende, a la necesidad de una intervención de Enfermería para disminuir estos niveles. Objetivo: Evaluar la efectividad de una intervención de Enfermería para disminuir la depresión de personas en el preoperatorio cardiovascular. Métodos: Estudio preexperimental con pretest y protest, en una población de 88 personas en el Servicio de Cirugía Cardiovascular en el Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba, desde marzo de 2019 a junio de 2020. La depresión fue medida con el test de Inventario de Depresión Rasgo-Estado. Se realizó una intervención de Enfermería sustentada en el Modelo de Adaptación de Sor Callista Roy, el Proceso de Atención de Enfermería y las taxonomías NANDA, NOC, NIC, para disminuir la depresión de personas en el preoperatorio cardiovascular. Los resultados se confrontaron y expresaron en porcentajes, media y números absolutos. Se utilizó la prueba de Chi cuadrado y probabilidad exacta de Fisher. La asociación de variables se obtuvo con la prueba no paramétrica de Wilcoxon, con regla de disociación: si p≤ 0,05 se rechaza HO. Resultados: El sexo masculino constituyó el 57,92 por ciento de los casos y la edad media fue de 57 años. Luego de la intervención se redujo la depresión en un 27,27 por ciento (p= 0,000). Conclusiones: La implementación de una intervención de Enfermería para disminuir la depresión de personas en el preoperatorio cardiovascular, sustentada en el Modelo de Adaptación de Sor Callista Roy, el PAE y las Taxonomías NANDA, NOC, NIC mostró efectividad, ya que se logró modificar de forma positiva y significativa la depresión, en tanto, optimizó los resultados posoperatorios(AU)

Introduction: During the preoperative period of cardiovascular surgery, people frequently present high levels of depression, associated with little favorable surgical outcomes and, therefore, with the need for a nursing intervention to reduce such levels. Objective: To evaluate the effectiveness of a nursing intervention to reduce depression in preoperative cardiovascular patients. Methods: A preexperimental study with pretest and protest was carried out in a population of 88 people in the cardiovascular surgery service at Centro de Investigaciones Médico-Quirúrgicas, in Havana, Cuba, from March 2019 to June 2020. Depression was measured using the State/Trait Depression Inventory test. A nursing intervention was performed, based on the Adaptation Model of Sister Callista Roy, the Nursing Care Process, as well as the NANDA, NOC and NIC taxonomies, in order to reduce depression in preoperative cardiovascular patients. The results were compared and expressed as percentages, mean and absolute numbers. The chi-square and Fisher's exact probability tests were used. The association of variables was obtained with the nonparametric Wilcoxon test, with the dissociation rule if p ≤ 0.05, H O is rejected. Results: The male sex accounted for 57.92 percent of the cases and the mean age was 57-years. After the intervention, depression was reduced by 27.27 percent (p= 0.000). Conclusions: The implementation of a nursing intervention to reduce depression in preoperative cardiovascular patients, based on the Adaptation Model of Sister Callista Roy, the Nursing Care Process, as well as NANDA, NOC and NIC taxonomies, showed effectiveness, since it was possible to modify depression in a positive and significant way, while optimizing postoperative outcomes(AU)

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ABSTRACT Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Several heart conditions have been associated with CKD, including myocardial and pericardial diseases. This paper describes a case of Dialysis-related constrictive pericarditis in a patient diagnosed with sudden hypotension during a hemodialysis session. A 65-year-old man diagnosed with hypertension, diabetes, obesity, and cirrhosis on hemodialysis for two years complained of symptoms during one of his sessions described as malaise, lipothymia, and confusion. The patient had a record of poor compliance with the prescribed diet and missed dialysis sessions. He was sluggish during the physical examination, and presented hypophonetic heart sounds, a blood pressure of 50/30mmHg, and a prolonged capillary refill time. The patient was referred to the intensive care unit and was started on antibiotics and vasoactive drugs. His workup did not show signs of infection, while electrocardiography showed low QRS-wave voltage. His echocardiogram showed signs consistent with a thickened pericardium without pericardial effusion. Cardiac catheterization showed equalization of diastolic pressures in all heart chambers indicative of constrictive pericarditis. The patient underwent a pericardiectomy. Examination of surgical specimens indicated he had marked fibrosis and areas of dystrophic calcification without evidence of infection, consistent with Dialysis-related constrictive pericarditis. Hypotension for unknown causes must be considered in the differential diagnosis of dialysis patients.

RESUMO A doença cardiovascular é a principal causa de morte em pacientes com doença renal crônica (DRC). Várias formas de acometimento cardíaco têm sido associadas. à DRC, incluindo doenças miocárdicas e pericárdicas. Este artigo descreve um caso de pericardite constritiva relacionada a em um paciente diagnosticado com hipotensão súbita durante uma sessão de hemodiálise. Um homem de 65 anos com diagnósticos prévios de hipertensão, diabetes, obesidade e cirrose em hemodiálise por dois anos queixou-se de sintomas durante uma de suas sessões, descritos como mal-estar, lipotímia e confusão mental. Apresentava histórico de baixa adesão à dieta prescrita e faltas frequentes às sessões de diálise. Ele estava fraco durante o exame físico e apresentava bulhas cardíacas hipofonéticas, pressão arterial de 50/30mmHg e tempo de enchimento capilar prolongado. O paciente foi encaminhado para a unidade de terapia intensiva e iniciou o tratamento com antibióticos e drogas vasoativas. Investigação laboratorial não mostrou sinais de infecção, enquanto o eletrocardiograma mostrou baixa voltagem de complexo QRS. Seu ecocardiograma evidenciou sinais consistentes com um pericárdio espessado, sem derrame pericárdico. O cateterismo cardíaco mostrou equalização das pressões diastólicas em todas as câmaras cardíacas, indicativo de pericardite constritiva. O paciente foi submetido a uma pericardiectomia. O exame anatomopatológico mostrou sinais de acentuada fibrose acentuada fibrose e áreas de calcificação distrófica sem evidência de infecção, consistente com pericardite constritiva relacionada a por diálise. A hipotensão por causas desconhecidas deve ser considerada no diagnóstico diferencial de pacientes em diálise.