A carregar...
Publicação
Synchronous carotid and cardiac surgery : a nested case-control study
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 327.34 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Contextualização: A aterosclerose é um processo patológico com início precoce na vida humana e é a etiologia mais comum no que toca a doença cerebrovascular, nomeadamente de estenose carotídea, e doença coronária. As indicações relativas à modalidade e fase temporal da revascularização carotídea, em doentes com doença coronária concomitante, tem sido o foco de discussão desde há vários anos, não existindo, até ao momento um consenso claro. No entanto, a literatura científica parece concordar que a cirurgia síncrona é segura com reduzidas taxas de complicações e de mortalidade global. Objetivo: Este trabalho propôs-se avaliar os resultados de curto e médio prazo da cirurgia síncrona carotídea e cardíaca, nomeadamente sucesso clínico e outcomes de segurança. Métodos: Realizou-se um estudo caso-controlo nested comparando doentes submetidos a cirurgia síncrona com doentes emparelhados submetidos apenas a cirurgia cardíaca. Os outcomes primários foram as diferenças na mortalidade a 30-dias e global, a ocorrência de AVC/AIT pós-operatório ou de enfarte agudo do miocárdio. Outcomes adicionais consistiram no tempo cirúrgico, quantificação das perdas de sangue e demais complicações pós-operatórias. Resultados: Os doentes submetidos a cirurgia síncrona (casos) foram 72.4% do sexo masculino, com idade média de 70.9 anos (SD 7.2), enquanto nos controlos 83.8% eram homens, com idade média de 69.8 anos (SD 7.7). Doentes do sexo feminino estavam presentes em maior número nos casos, que nos controlos (p=0.02). O EUROSCORE aferido nos casos foi superior ao dos controlos (p=0.001). Não existiram diferenças significativas em relação à mortalidade a 30-dias e mortalidade global, bem como na incidência de AVC ou EAM, entre os dois grupos (p=0.6, p=0.7 e p=0.6, p=0.2 respetivamente). Constatou-se, contudo, uma incidência de lesão renal aguda mais elevada, nos casos (OR: 4.87; 95% CI: 1.63-14.53 p=0.005), e inferior de bradicardia (OR: 0.03; 95% CI: 0.001-0.75 p=.033). Nos restantes outcomes, não se encontraram diferenças significativas após uma análise multivariada. Conclusão: Assim, na cirurgia síncrona carotídea e cardíaca não se verificou aumento da mortalidade, quer a 30-dias, quer global, nem aumento da incidência de AVC/AIT ou EAM, quando comparado com doentes submetidos apenas a cirurgia cardíaca. Ainda que EUROSCORE mais elevado se encontre associado a um aumento dos riscos de mortalidade e complicações pós-operatórias, o nosso trabalho demonstra que a cirurgia síncrona é uma abordagem segura, bem tolerada e com baixo risco cirúrgico.
Background: Atherosclerosis is a pathologic condition that begins early in life, and is the main responsible for Cerebral Vascular Disease, namely Carotid Artery Stenosis, and Coronary Artery Disease. Proper time and modality for carotid revascularization, in coexisting Coronary Artery Disease, has been in discussion for many years with no consensus reached so far. Nonetheless, literature seems to agree that a synchronous approach is safe with a low overall mortality and complication rate. Objective: The aim of this study was to evaluate early and mid-term results of synchronous carotid and cardiac surgery, regarding clinical success and safety outcomes. Methods: A nested case-control study was performed comparing patients who were submitted to synchronous carotid and cardiac surgery to matched patients who were submitted to cardiac surgery alone. Primary outcomes were: differences in thirty-day and overall mortality; post-operative stroke/TIA and myocardial infarction. Additional outcomes were differences in surgery-time, blood loss, and other post-operative complications. Results: Cases were 72.4% male with a mean age of 70.9 years (SD 7.2), while controls were 83.8% male and 69.8 years old (SD 7.7). Cases had more females patients than controls (p=0.02). The EUROSCORE was higher in cases than in controls (p=0.001). There was no significant difference regarding thirty-day and overall mortality, as well as stroke and myocardial infarction rates, between both groups (p=0.6, p=0.7 and p=0.6, p=0.2 respectively). Acute Kidney Injury was seen to happen more in cases (OR: 4.87; 95% CI: 1.63-14.53 p=0.005), while bradycardia occurred less (OR: 0.03; 95% CI: 0.001-0.75 p=.033). All other outcomes showed no significant differences after multivariate analysis. Conclusion: The Synchronous approach did not increase thirty-day and overall mortality, or post-operative stroke/TIA and myocardial infarction rates, compared to a single cardiac procedure. Though a higher EUROSCORE is usually associated with higher risks of mortality and post-operative complications, the synchronous surgery in our study was shown to be a safe, well-tolerated and a low-risk procedure.
Background: Atherosclerosis is a pathologic condition that begins early in life, and is the main responsible for Cerebral Vascular Disease, namely Carotid Artery Stenosis, and Coronary Artery Disease. Proper time and modality for carotid revascularization, in coexisting Coronary Artery Disease, has been in discussion for many years with no consensus reached so far. Nonetheless, literature seems to agree that a synchronous approach is safe with a low overall mortality and complication rate. Objective: The aim of this study was to evaluate early and mid-term results of synchronous carotid and cardiac surgery, regarding clinical success and safety outcomes. Methods: A nested case-control study was performed comparing patients who were submitted to synchronous carotid and cardiac surgery to matched patients who were submitted to cardiac surgery alone. Primary outcomes were: differences in thirty-day and overall mortality; post-operative stroke/TIA and myocardial infarction. Additional outcomes were differences in surgery-time, blood loss, and other post-operative complications. Results: Cases were 72.4% male with a mean age of 70.9 years (SD 7.2), while controls were 83.8% male and 69.8 years old (SD 7.7). Cases had more females patients than controls (p=0.02). The EUROSCORE was higher in cases than in controls (p=0.001). There was no significant difference regarding thirty-day and overall mortality, as well as stroke and myocardial infarction rates, between both groups (p=0.6, p=0.7 and p=0.6, p=0.2 respectively). Acute Kidney Injury was seen to happen more in cases (OR: 4.87; 95% CI: 1.63-14.53 p=0.005), while bradycardia occurred less (OR: 0.03; 95% CI: 0.001-0.75 p=.033). All other outcomes showed no significant differences after multivariate analysis. Conclusion: The Synchronous approach did not increase thirty-day and overall mortality, or post-operative stroke/TIA and myocardial infarction rates, compared to a single cardiac procedure. Though a higher EUROSCORE is usually associated with higher risks of mortality and post-operative complications, the synchronous surgery in our study was shown to be a safe, well-tolerated and a low-risk procedure.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Cirurgia síncrona Endarterectomia carotídea Cirurgia cardíaca Mortalidade Acidente vascular cerebral Cirurgia vascular