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ARTIGO ORIGINAL

Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total

Eduardo Keller SaadiI; Darryl ShoreII; Christopher LincolnII

DOI: 10.1590/S0102-76381993000200009

RESUMO

Pacientes com defeito septal atrioventricular de forma total (DSAVT) freqüentemente apresentam insuficiência cardíaca intratável e hipertensão arterial pulmonar nos primeiros meses de vida, e apenas uma minoria sobrevive sem tratamento cirúrgico precoce. Por essa razão, indica-se a correção definitiva para alterar favoravelmente a história natural da doença. Entretanto, vários fatores são responsáveis pela alta mortalidade cirúrgica. O presente trabalho estuda a experiência na correção cirúrgica do DSAVT com o objetivo de identificar alguns fatores de risco estatisticamente significativos para a ocorrência de morte operatória. Analisaram-se, retrospectivamente, 52 pacientes submetidos, entre janeiro de 1974 e dezembro de 1990, a cirurgia definitiva para correção de DSAVT no Royal Brompton and National Heart and Lung Institute, sendo estudadas as seguintes variáveis: idade, peso, sexo, ano da operação, presença de síndrome de Down, grau de regurgitação da valva AV, bandagem prévia do tronco pulmonar, presença de anomalias associadas, pressão sistólica pulmonar, duplo orifício mitral, classificação do defeito segundo Rastelli, emprego de parada circulatória e técnica de correção (1 x 2 retalhos). Todos os fatores foram avaliados isoladamente, mediante a análise univariada. Para determinar quais os fatores que, independentemente da ação de outros, contribuíram significativamente para maior mortalidade cirúrgica, foi utilizada a análise multivariada com regressão logística. A análise multivariada demonstrou que o baixo peso na época da operação e a técnica de correção com um retalho aumentam significativamente a mortalidade cirúrgica.

ABSTRACT

Patients with complete atrioventricular septal defects (CAVSD) frequently present with severe heart failure which cannot be controllable medically and pulmonary hypertension in infancy. Just a small number survives without early surgical treatment. For this reason the definitive repair is indicated to improve the disease's natural history. However many factors are responsible for a still high surgical mortality in this condition. In the present study the surgical experience in the correction of CAVSD is reviewed in order to identify potential statistically important risk factors for operative death. Between January 1974 and December 1990,52 patients with complete atrioventricular septal defects underwent definitive surgical repair at The Royal Brompton and National Heart and Lung Institute. They were retrospectively studied and the following variables analysed: age, weight, sex, year of the operation, Down's syndrome, atrioventricular valve regurgitation, previous pulmonary artery banding, associated anomalies, systolic pulmonary artery pressure, double "mitral" valve orifice, Rastelli's classification, circulatory arrest, and the surgical technique (1 x 2 patches). All this variables were studied by the univariate analysis and, to determine which factors were independently responsible for the operative risk, multivariate analysis with logistic regression was applied. Multivariate analysis showed that the low weight at operation an 1 patch technique significantly increased surgical mortality.
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