Resultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte

Abstract

Abstract Background The short-term results after using arterial grafts still raise questions and doubts for medical society. Objective To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery. Methods Cross-sectional cohort study in the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (<6 days), prolonged hospital stay (>14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk. Results After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048). Conclusion Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin ≥6.40%, had a greater influence on the infectious outcome than the choice of grafts. shortterm term society surgery Crosssectional Cross sectional REPLICCAR II. . II) 312 used compared reoperation , (DSWI) stroke injury >24 24 (>2 hours, hours hours) <6 6 (< days, days days) >14 14 (>1 PSM (PSM 106 risk age smokers hypertension diabetes angina infarction males surgeries procedure p=0.042, p0042 p p=0.042 0 042 (p=0.042) p=0.01, p001 p=0.01 01 (p=0.01) p=0.006, p0006 p=0.006 006 (p=0.006) p=0.007, p0007 p=0.007 007 (p=0.007) p=0.015 p0015 015 (p=0.015 however p=0.005, p0005 p=0.005 005 (p=0.005) p=0.002 p0002 002 (p=0.002 p=0.036. p0036 p=0.036 036 (p=0.036) rate 640 40 >6.40 p=0.048. p0048 p=0.048 048 (p=0.048) complications ≥6.40% 31 (DSWI >2 2 (>< ( >1 1 10 p004 p=0.04 04 (p=0.042 p00 p=0.0 (p=0.01 p000 p=0.00 00 (p=0.006 (p=0.007 (p=0.005 (p=0.00 p003 p=0.03 03 (p=0.036 64 4 >6.4 (p=0.048 ≥6.40 3 > (p=0.04 p0 p=0. (p=0.0 (p=0.03 >6. ≥6.4 p=0 (p=0. >6 ≥6. p= (p=0 ≥6 (p= ≥ (p