Cirurgia de revascularização do miocárdio no Brasil: análise crítica da realidade nacional através do registro Bypass

• Ano de defesa: 2019
• Autor(a) principal: Paez, Rodrigo Pereira [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300001cdxt
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Database; Registries; Cardiovascular Surgery; Cardiac Surgery; Coronary Artery Bypass Grafting; Banco De Dados; Registros; Cirurgia Cardiovascular; Cirurgia Cardíaca; Revascularização Do Miocárdio
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=8066031; https://repositorio.unifesp.br/handle/11600/59235

Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a registry database on surgical practice and results. Anticipating this recommendation, the BYPASS registry started in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: This is a cross-sectional study of 2292 patients undergoing CABG and included in the BYPASS Registry up to November, 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in the Registry were predominantly male (71%), with previous myocardial infarction in 41.1% of cases, diabetes in 42.5%, and left ventricular ejection fraction lower than 40% in 9.7%. Surgery was indicated by Heart Team in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), where the use of cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery (ITA) was used as graft in 91% of the cases; the right ATI, in 5.6%; and; the radial artery, in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of stroke was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS registry analysis is representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.