Palavras-chave
Complicações Perioperatórias
Reabilitação Cardíaca
Recuperação Pós-Operatória
Como Citar
Resumo
A revascularização miocárdica (CRM) em pacientes idosos é uma intervenção cirúrgica essencial para o tratamento de doenças coronarianas graves, mas que apresenta desafios únicos devido à fragilidade e às comorbidades frequentemente presentes nessa população. Este estudo teve como objetivo revisar a literatura existente para avaliar os fatores de risco e os resultados a longo prazo em idosos submetidos à CRM. A metodologia consistiu em uma revisão integrativa de artigos publicados entre 2013 e 2023, utilizando bases de dados como PubMed, SciELO, LILACS e Google Acadêmico. Foram incluídos estudos que abordavam a CRM em pacientes com 65 anos ou mais, focando em fatores como a fragilidade, comorbidades e técnicas cirúrgicas. Os resultados indicam que a fragilidade e comorbidades como diabetes e insuficiência cardíaca aumentam significativamente o risco de complicações perioperatórias e mortalidade. A escolha da técnica cirúrgica, entre CRM convencional e off-pump, também desempenha um papel crucial nos desfechos, com a técnica off-pump associada a uma menor incidência de complicações em alguns casos, embora sua eficácia a longo prazo ainda seja debatida. A recuperação e a qualidade de vida pós-operatória são influenciadas pela presença de fragilidade e pela adesão a programas de reabilitação cardíaca, que se mostraram fundamentais para melhorar os resultados a longo prazo. Em conclusão, apesar dos desafios, a CRM pode oferecer benefícios substanciais para pacientes idosos, desde que sejam cuidadosamente selecionados e manejados de forma personalizada e multidisciplinar. A pesquisa contínua e o desenvolvimento de estratégias de reabilitação adaptadas são essenciais para otimizar os desfechos e melhorar a qualidade de vida nessa população crescente.
Referências
AKHRASS, R.; BAKAEEN, F. G. Multi-arterial Coronary Grafting. Operative Techniques in Thoracic and Cardiovascular Surgery, Volume 27, Issue 2 , Summer 2022, Pages 126-146.
ARTEAGA, A. S. et al. Long-term influence of frailty in elderly patients after surgical emergencies. Eur J Trauma Emerg Surg. 2022 Oct;48(5):3855-3862.
BARONOS, S.; WHITFORD, R. C.; ADKINS, K. Postoperative care after left ventricular assist device implantation: considerations for the cardiac surgical intensivist. Indian J Thorac Cardiovasc Surg. 2023 Jul;39(Suppl 1):182-189.
BOŻENA CYGANROWICZ, B.; MILANIAK, I. The effect of a preoperative education program on the quality of life and the reduction of symptoms of anxiety and depression in patients undergoing a coronary artery bypass graft surgery – a quasi-experimental study. Nursing Problems. 2024; 32 (2): 77-84
BRUNKER, L. B. et al. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging. 2023 Jan 22;18:93-112.
CHAN, J. et al. On- versus off-pump CABG in octogenarians: A propensity-matched analysis from the UK National Database. J Card Surg. 2022 Dec;37(12):4705-4712.
CORDEIRO, A. L. L. et al. Behavior of Pulmonary Function after Hospital Discharge in Patients Submitted to Myocardial Revascularization. Int J Cardiovasc Sci. 2019Mar;32(2):104–9.
D'ALESSANDRO, S. et al. The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis. Heart Vessels. 2022 Oct;37(10):1647-1661.
DAMLUJI, A. A. et al. American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; and Council on Lifestyle and Cardiometabolic Health. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation. 2023 Jan 17;147(3):e32-e62.
DIBBEN, G. et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021 Nov 6;11(11):CD001800.
DIMAGLI, A. et al. Angiographic Outcomes for Arterial and Venous Conduits Used in CABG. J Clin Med. 2023 Mar 3;12(5):2022.
DUARTE, Y. A. O. et al. Fragilidade em idosos no município de São Paulo: prevalência e fatores associados. Rev bras epidemiol. 2018;21:e180021.
DYBIEC, J. et al. Structural and Functional Changes in Aging Kidneys. Int. J. Mol. Sci. 2022, 23(23), 15435.
GUERRERO-ORRIACH, J. L.; CARMONA-LUQUE, M. D.; GONZALEZ-ALVAREZ, L. Heart Failure after Cardiac Surgery: The Role of Halogenated Agents, Myocardial Conditioning and Oxidative Stress. Int J Mol Sci. 2022 Jan 25;23(3):1360.
JAVED, H. et al. Challenges and Solutions in Postoperative Complications: A Narrative Review in General Surgery. Cureus. 2023 Dec 22;15(12):e50942.
JIANG, Y. et al. Beating-heart on-pump coronary artery bypass grafting vs. off-pump coronary artery bypass grafting: a systematic review and meta-analysis. Journal of Thoracic Disease. vol 13, n. 7, 2021.
JUDAS, M. C. L. et al. Effectiveness of Early Mobilization in Prevention and Rehabilitation of Functional Impairment After Myocardial Revascularization Surgery: A Systematic Review. International Journal of Cardiovascular Sciences. 11/Jul/2023;36:e20210166.
KARABDIC, I. H. et al. Off pump Versus On pump Coronary Artery Bypass Grafting: Short-term Outcomes. Acta Inform Med. 2023 Jun;31(2):107-110.
KODEBOINA, M. et al. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. Int J Environ Res Public Health. 2023 Apr 25;20(9):5633.
LAWTON, J. S. et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. v. 145, n. 3, 2021.
LEMAIRE, A. et al. The impact of age on outcomes of coronary artery bypass grafting. J Cardiothorac Surg. 2020 Jul 1;15(1):158.
LEMOS, L. H. B. et al. Endocardite Infecciosa em Idosos: Características Distintas. Arq. Bras. Cardiol. 2021; 117(4): 775-781.
LIAO, Y. C. et al. Preoperative renal insufficiency predicts postoperative adverse outcomes in a mixed surgical population: a retrospective matched cohort study using the NSQIP database. Int J Surg. 2023 Apr 1;109(4):752-759.
LIGA, R. et al. Myocardial Revascularization in Patients With Ischemic Cardiomyopathy: For Whom and How. J Am Heart Assoc. 2023 Mar 21;12(6):e026943.
LOBDELL, K. W. et al. Technological advances to enhance recovery after cardiac surgery. Journal of Hospital Management and Health Policy. Vol 5 (September 25, 2021).
MACEDO, A. C. L. et al. Postoperative Period of Myocardial Revascularization Surgery: Retrospective Cohort Study of a Single Center. Brazilian Journal of Cardiovascular Surgery, 38(5), e20220332, 2023.
MAULDON, H. et al. Effect of Age on Clinical Outcomes Following On-/Off-Pump Coronary Artery Bypass: MetaAnalysis and Meta-Regression. Braz J Cardiovasc Surg. 2020;35(5):797-814.
MW, M. et al. II Diretriz Brasileira de Insuficiência Cardíaca Aguda. Arq Bras Cardiol. 2009;93(3):2–65.
NAITO, S. et al. Impact of Surgeon Experience and Centre Volume on Outcome After Off-Pump Coronary Artery Bypass Surgery: Results From the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Registry. Heart Lung Circ. 2023 Mar;32(3):387-394.
NASCIMENTO, D. M. et al. Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? – A Retrospective Cohort Study. International Journal of Cardiovascular Sciences. 04/May/2022;35(6):760-9.
NTINOPOULOS, V. et al. Conversion from off-pump to on-pump coronary artery bypass grafting: impact of surgeon and anaesthetist experience. Interdiscip Cardiovasc Thorac Surg. 2023 Dec 5;37(6):ivad205.
OZGUR, M. M. et al. of minimal invasive extracorporeal circulation versus standard cardiopulmonary bypass systems on coronary artery bypass surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Apr 30;32(2):141-150.
PAN, R. et al. Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting: a retrospective case-control study. BMC Anesthesiol. 2023 Feb 28;23(1):63.
PINHEIRO, T. C. E. et al. ClinicalFrailtyScale em idosos atendidos no Serviço Hospitalar de Emergência: a fragilidade basal é um bom preditor de mortalidade em 90 dias? Rev. Bras. Geriatr. Gerontol. 2021;24(4):e210122
POZZI, M. et al. The frail patient undergoing cardiac surgery: lessons learned and future perspectives. Front Cardiovasc Med. 2023 Dec 6;10:1295108.
SACHDEVA, P. et al. Advancements in Myocardial Infarction Management: Exploring Novel Approaches and Strategies. Cureus. 2023 Sep 19;15(9):e45578.
SALMON, T. et al. The Impact of Frailty and Comorbidities on Heart Failure Outcomes. Card Fail Rev. 2022 Mar 21;8:e07.
SANTOS, N. C. D. et al. Prevalence and Impact of Comorbidities in Individuals with Chronic Obstructive Pulmonary Disease: A Systematic Review. Tuberc Respir Dis (Seoul). 2022 Jul;85(3):205-220.
SCHMIDT-RIOVALLE, J. et al. Quality of Life After Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020 Nov 14;17(22):8439.
STEINMETZ, C. et al. Prehabilitation in patients awaiting elective coronary artery bypass graft surgery - effects on functional capacity and quality of life: a randomized controlled trial. Clin Rehabil. 2020 Oct;34(10):1256-1267.
THAKARE, V. S. et al. Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review. Cureus. 2023 Sep 18;15(9):e45511.
VERMA, S. et al. Off-Pump Coronary Artery Bypass Surgery: Fundamentals for the Clinical Cardiologist. Circulation. v. 109, n. 10, 2014.
ZAREE, A. Cardiac Rehabilitation in the Modern Era: Optimizing Recovery and Reducing Recurrence. Cureus. 2023 Sep 26;15(9):e46006.
ZHANG, R. J. et al. Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study. J Cardiothorac Surg. 2023 Feb 1;18(1):53.
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Copyright (c) 2024 José Amarildo Avanci Júnior, Natalia Macedo, Beatriz Corrêa Lyrio, Gustavo Eduardo Rocha, Fernanda Christinne Alves Bento, Lucas Oliveira Morais, Milene Alves de Souza Almeida, Ana Paula Flores dos Santos, Georgia Gomes Lima Martins, Diana Casarin Kronhardt, Stefany Giroleta Venuto, Thais Helena Kirchesch e Costa, Marcelo Fontes da Silva