Postoperative Complications

IJCS

Original Article

Transcatheter Aortic Valve Implantation in Nonagenarians: In-Hospital Complications and One-Year Follow-Up Mortality

Nelson Durval Ferreira Gomes de Mattos et al. Rafael Lauria de Oliveira Constantino Gonzalez Salgado André Luiz Silveira Sousa … Andre Luiz da Fonseca Feijó Rodrigo Verney Castello Branco Giovanna Zadra de Mattos José Carlos Pizzolante Secco Luiz Antonio Ferreira Carvalho Helena Cramer Rey

Abstract

Background:

Aortic Stenosis (AS) is prevalent among elderly individuals and is associated with high mortality when untreated. Transcatheter Aortic Valve Implantation (TAVI) has emerged as a viable therapeutic alternative, particularly for patients with surgical contraindications. However, its application in nonagenarians remains controversial due to limited data in this very elderly population.

Objective:

To evaluate clinical outcomes in nonagenarian patients undergoing TAVI at a private quaternary hospital, with emphasis on mortality and in-hospital as well as one-year complications.

Methods:

A retrospective cohort study with prospective follow-up was conducted between 2009 and 2023. A total of 265 patients with symptomatic severe AS who underwent TAVI were included, of whom 40 were nonagenarians (≥ 89 years). Data were obtained from an institutional database and from the Brazilian Registry of Aortic Bioprosthesis Implantation by Catheter – New Technologies (RIBAC-NT). Comparisons between nonagenarians and younger patients were performed using the Student’s t-test for continuous variables and the chi-square (χ²) test for categorical variables. A p-value < 0.05 was considered statistically significant.

Results:

Among nonagenarians, 55% were female, 72.5% had hypertension, and 95% had chronic kidney disease. The technical success rate was 55%. Major complications included permanent pacemaker implantation (35%) and adverse events (45%). In-hospital mortality was 7.9%, with no statistically significant differences at 30 days (p = 0.40), 6 months (p = 0.35), and one year (p = 0.06) compared to younger patients.

Conclusion:

TAVI proved to be a safe and effective therapeutic option in nonagenarians, showing clinical outcomes comparable to those of younger individuals.

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IJCS

Original Article

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Joseane de Souza Ribeiro et al. Maria Liz Cunha de Oliveira

Abstract

Background:

The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice.

Objective:

To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018.

Methods:

Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents.

Results:

From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months.

Conclusion:

The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

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IJCS

Original Article

Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? – A Retrospective Cohort Study

Daniela Meirelles do Nascimento et al. Cíntia Ehlers Botton Felipe Vargas Santos Márcia Cristina Rover … Marília Santos Moura Bruna Müller Leão Beatriz D. Schaan

Abstract

Background

Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age.

Objective

To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery.

Methods

A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted.

Results

The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015).

Conclusions

Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

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IJCS

Editorial

Postoperative Atrial Fibrillation: The Challenge of Risk Prediction

Luiz Eduardo Montenegro Camanho et al. Gustavo Vignoli dos Santos

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and is characterized by chaotic activation of the atrium, with f waves present on baseline electrocardiography. Postoperative atrial fibrillation (POAF) is a clinically important complication in patients who underwent heart surgery (coronary artery bypass grafting, or CABG surgery, or valvular surgery). The prevalence of POAF varies from 20 to 40%, with a peak incidence between days two and four after heart surgery.^, Studies suggest that patients undergoing CABG alone have lower incidence of POAF (10 to 40%) compared with those undergoing CABG combined with heart valve replacement (62%).

The most important risk factors associated with this condition are advanced age, heart failure, rheumatic heart disease, hypertension, previous history of AF, left atrial enlargement, chronic kidney failure, and chronic obstructive pulmonary disease (COPD).

[…]

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IJCS

Original Article

Left Atrial Size Contribution to the Predictive Capacity of Two Scores for Atrial Fibrillation in the Postoperative Period of Cardiac Surgeries

Natália Aline da Silva et al. Rita de Cássia Gengo e Silva Butcher

Abstract

Background:

Postoperative atrial fibrillation (POAF) is a common complication associated with undesirable outcomes; hence, the provision of appropriate tools is important to help identify patients at risk.

Objectives:

To evaluate the predictive capacity of the CHADS₂ and CHA₂DS₂-VASc scores, alone and combined with left atrial (LA) size, for the onset of POAF in patients undergoing coronary artery bypass grafting and/or valvular surgery.

Methods:

We performed a retrospective cohort study on 144 patients. A decision tree was used to identify the cut-off values of the CHADS₂ and CHA₂DS₂-VASc scores and LA size in order to calculate sensitivity, specificity, predictive-value positive (PVP), and predictive-value negative (PVN), in addition to regression models. The receiver operating characteristic (ROC) curve was used to estimate the accuracy of the models. The level of significance adopted was 5%.

Results:

Patients who developed POAF were older (p = 0.050), had reduced left ventricular ejection fraction (p = 0.045), longer hospital length of stay (p = 0,018), but their mean CHADS₂ (p = 0.077) and CHA₂DS₂-VASc (p = 0.109) scores were similar to those of patients with no arrhythmia. LA size improved the predictive capacity of the CHADS₂ score, in terms of specificity and PVP, and of the CHA₂DS₂-VASc score, in terms of sensitivity and PVN. However, the CHADS₂ (OR = 1.198; CI95% = 0.859-1.156) and CHA₂DS₂-VASc (OR = 1.047; CI95% = 0.784-1.401) scores were not predictors of POAF, either alone or in combination with LA size (OR = 1.163; CI95% = 0.829-1.648 and OR = 1.065; CI95% = 0.795-1.433).

Conclusion:

The CHADS₂ and CHA₂DS₂-VASc scores alone or in combination with LA size did not show good predictive capacity for POAF.

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Original Article

Clinical Course of Patients Undergoing Myocardial Revascularization Surgery in a Public Cardiology Referral Hospital in Pará, Brazil

Patrick Hernani Matias Lobato et al. Feliciano Mendes Vieira Junior Mário Barbosa Guedes Nunes Valleria Adriana Queiroz Lima Galucio Ercielem da Lima Barreto

Abstract

Background:

Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce.

Objective:

To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon.

Methods:

Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014.

Results:

A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 – 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 – 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 – 39.54, p = 0.001) were predictors of mortality after CABG.

Conclusion:

A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil.

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