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| Natura: | Artículo científico |
| Lingua: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2015
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| Accesso online: | https://www.redalyc.org/articulo.oa?id=398941897006 |
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- Atrioventricular block in coronary artery bypass surgery: perioperative predictors and impact on mortality Ricardo Medeiros Piantá Andres Di Leoni Ferrari Aline Almeida Heck Débora Klein Ferreira Jacqueline da Costa Escobar Piccoli Luciano Cabral Albuquerque João Carlos Vieira da Costa Guaragna João Batista Petracco Medicina Artificial Pacemaker Coronary Artery Bypass Atrioventricular block Postoperative Complications Introduction: Disturbances of the cardiac conduction system are frequent in the postoperative period of coronary artery bypass surgery. They are mostly reversible and associated with some injury of the conduction tissue, caused by the ischemic heart disease itself or by perioperative factors. Objective: Primary: investigate the association between perioperative factors and the emergence of atrioventricular block in the postoperative period of coronary artery bypass surgery. Secondary: determine the need for temporary pacing and of a permanent pacemaker in the postoperative period of coronary artery bypass surgery and the impact on hospital stay and hospital mortality. Methods: Analysis of a retrospective cohort of patients sub - mitted to coronary artery bypass surgery from the database of the Postoperative Heart Surgery Unit of the Sao Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, using the logistic regression method. Results: In the period from January 1996 to December 2012, 3532 coronary artery bypass surgery were carried out. Two hundred and eighty-eight (8.15% of the total sample) patients had atrioventricular block during the postoperative period of coronary artery bypass surgery, requiring temporary pacing. Eight of those who had atrioventricular block progressed to implantation of a permanent pacemaker (0.23% of the total sample). Multivariate analysis revealed a significant association of atrioventricular block with age above 60 years (OR=2.34; CI 95% 1.75-3.12; P <0.0001), female gender (OR=1.37; CI 95% 1.06-1.77; P =0.015), chronic kidney disease (OR=2.05; CI 95% 1.49-2.81; P <0.0001), atrial fibrillation (OR=2.06; CI 95% 1.16-3.66; P =0.014), functional class III and IV of the New York Heart Association (OR=1.43; CI 95% 1.03-1.98; P =0.031), perioperative acute myocardial infarction (OR=1.70; CI 95% 1.26-2.29; P <0.0001) and with the use of the intra-aortic balloon in the postoperative period of coronary artery bypass surgery (OR=1.92; CI 95% 1.21-3.05; P =0.006). The presence of atrio - ventricular block resulted in a significant increase in mortality (17.9% vs. 7.3% in those who did not develop atrioventricular block) (OR=2.09; CI 95% 1.46-2.99; P <0.0001) and a longer hos - pital stay (12.75 days x 10.53 days for those who didn’t develop atrioventricular block) (OR=1.01; CI 95% 1.00-1.02; P =0.01). Conclusions: In most cases, atrioventricular block in the postoperative period of coronary artery bypass surgery is transient and associated with several perioperative factors: age above 60 years, female sex, chronic kidney disease, atrial fibrillation, New York Heart Association functional class III or IV, perioperative acute myocardial infarction and use of an intra-aortic balloon. Its occurrence prolongs hospitalization and, above all, doubles the risk of mortality. 2015 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941897006 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.2 Vol.30