Preditores de disfunção neurológica maior após cirurgia de revascularização miocárdica isolada

Abstract

Introduction: Patients who undergo myocardial revascularization procedures (CABG) are prone to neurologic dysfunction. Significant neurologic problems implicate a higher mortality rate and permanent functional deficiencies. Objective: The aim of this study was to evaluate the incidence and to identify possible predictors of major postoperative neurologic dysfunction (defined as stroke) and to evaluate early clinical outcomes in a non-selected cohort. Method: A total of 1760 consecutive patients, who underwent CABG in isolation in the San Lucas Hospital - PUCRS between January 1997 and February 2004, were enrolled. Demographic and laboratory data, information regarding the procedure and perioperative endpoints were collected prospectively using a standard protocol data register of the postoperative heart unit in our hospital. Variables with a p-value of no greater than 0.05 given a confidence interval of 95% were considered statistically significant. Results: In this study, 52 (3%) patients presented with major neurologic dysfunction. In the univariable analysis advanced age, higher prevalence of obstructive pulmonary disease, prior cerebrovascular disease, high mean fibrinogen levels, the occurrence of shock or severe hypotension, presence of supraventricular tachycardia (atrial fibrillation or flutter), occurrence of systemic inflammatory syndrome and prolonged mechanical ventilation were associated with stroke. In the multivariable analysis prior history of cerebrovascular disease and obstructive pulmonary disease presented as independent predictors for the occurrence of major neurologic dysfunction. Prolonged mechanical ventilation was also independently associated with this complication. Furthermore, the occurrence of stroke significantly increased the duration of hospital stay and inhospital mortality. Conclusion: Neurological dysfunction is still a significant cause of morbidity after CABG.