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. 2020 Oct;115(4):595-601.
doi: 10.36660/abc.20190145.

Current Impact of Cardiopulmonary Bypass in Coronary Artery Bypass Grafting in São Paulo State

[Article in English, Portuguese]
Gabrielle Barbosa Borgomoni  1 , Omar Asdrúbal Vilca Mejia  1   2 , Bianca Maria Maglia Orlandi  1 , Maxim Goncharov  1 , Luiz Augusto Ferreira Lisboa  1 , Pedro Henrique Conte  3 , Marco Antonio Praca Oliveira  3 , Alfredo Inácio Fiorelli  1 , Orlando Petrucci Junior  4 , Marcos Grandim Tiveron  5 , Luís Alberto de Oliveira Dallan  1 , Fabio Biscegli Jatene  1
Affiliations

Current Impact of Cardiopulmonary Bypass in Coronary Artery Bypass Grafting in São Paulo State

[Article in English, Portuguese]
Gabrielle Barbosa Borgomoni et al. Arq Bras Cardiol. 2020 Oct.

Abstract
in English, Portuguese

Background: Previous results on the use of cardiopulmonary bypass (CPB) have generated difficulties in choosing the best treatment for each patient undergoing myocardial revascularization surgery (CABG) in the current context.

Objective: Evaluate the current impact of CPB in CABG in São Paulo State.

Methods: A total of 2905 patients who underwent CABG were consecutively analyzed in 11 São Paulo State centers belonging to the São Paulo Registry of Cardiovascular Surgery (REPLICCAR) I. Perioperative and follow-up data were included online by trained specialists in each hospital. Associations of the perioperative variables with the type of procedure and with the outcomes were analyzed. The study outcomes were morbidity and operative mortality. The expected mortality was calculated using EuroSCORE II (ESII). The values of p <5% were considered significant.

Results: There were no significant differences concerning the patients' age between the groups (p=0.081). 72.9% of the patients were males. Of the patients, 542 underwent surgery without CPB (18.7%). Of the preoperative characteristics, patients with previous myocardial infarction (p=0.005) and ventricular dysfunction (p=0.031) underwent surgery with CPB. However, emergency or New York Heart Association (NYHA) class IV patients underwent surgery without CPB (p<0.001). The ESII value was similar in both groups (p=0.427). In CABG without CPB, the radial graft was preferred (p<0.001), and in CABG with CPB the right mammary artery was the preferred one (p<0.001). In the postoperative period, CPB use was associated with reoperation for bleeding (p=0.012).

Conclusion: Currently in the REPLICCAR, reoperation for bleeding was the only outcome associated with the use of CPB in CABG. (Arq Bras Cardiol. 2020; 115(4):595-601).

Fundamento: Resultados prévios com o uso de circulação extracorpórea (CEC) geram dificuldades na escolha do melhor tratamento para cada paciente na cirurgia de revascularização miocárdica (CRM) no contexto atual.

Objetivo: Avaliar o impacto da CEC no cenário atual da CRM no estado de São Paulo.

Métodos: Foram analisados 2.905 pacientes submetidos à CRM de forma consecutiva em 11 centros do estado de São Paulo pertencentes ao Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) I. Dados perioperatórios e de seguimento foram colocados via on-line por especialistas treinados e capacitados em cada hospital. Foram analisadas as associações das variáveis perioperatórias com o tipo de procedimento (com ou sem CEC) e com os desfechos. A mortalidade esperada foi calculada por meio do EuroSCORE II (ESII). Os valores de p menores de 5% foram considerados significativos.

Resultados: Não houve diferença significativa em relação à idade dos pacientes entre os grupos (p=0,081). Dentre os pacientes, 72,9% eram de sexo masculino; 542 pacientes foram operados sem CEC (18,7%). Das características pré-operatórias, pacientes com infarto agudo do miocárdio (IAM) prévio (p=0,005) e disfunção ventricular (p=0,031) foram operados com CEC; no entanto, pacientes de emergência ou em classe funcional New York Heart Association (NYHA) IV foram operados sem CEC (p<0,001). O valor do ESII foi semelhante para ambos os grupos (p=0,427). Na CRM sem CEC, houve preferência pelo uso do enxerto radial (p<0,001) e com CEC pela artéria mamária direita (p<0,001). No pós-operatório, o uso de CEC esteve associado com reoperação por sangramento (p=0,012).

Conclusão: Atualmente, no REPLICCAR, reoperação por sangramento foi o único desfecho associado ao uso da CEC na CRM. (Arq Bras Cardiol. 2020; 115(4):595-601).

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Conflict of interest statement

Potencial Conflito de Interesses

Declaro não haver conflito de interesses pertinentes.

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